Provider Demographics
NPI:1073788899
Name:BROWN, CYNTHIA M (PT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W DOMINICK ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-4816
Mailing Address - Country:US
Mailing Address - Phone:315-337-1533
Mailing Address - Fax:315-337-1531
Practice Address - Street 1:405 W DOMINICK ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-4816
Practice Address - Country:US
Practice Address - Phone:315-337-1533
Practice Address - Fax:315-337-1531
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015218-1225100000X
NY002389-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist