Provider Demographics
NPI:1063502888
Name:KULAK, CYNTHIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:KULAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:KULAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2207 SIMMONS ST
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3645
Mailing Address - Country:US
Mailing Address - Phone:903-983-2777
Mailing Address - Fax:
Practice Address - Street 1:1200 DUDLEY RD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3306
Practice Address - Country:US
Practice Address - Phone:903-984-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist