Provider Demographics
NPI:1063009967
Name:MALDONADO, CYNTHIA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 N ELSTON AVE # C1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4262
Mailing Address - Country:US
Mailing Address - Phone:773-677-3412
Mailing Address - Fax:
Practice Address - Street 1:3852 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3622
Practice Address - Country:US
Practice Address - Phone:773-355-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960052372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer