Provider Demographics
NPI:1073952115
Name:GELLINGER, CYNTHIA ANN (LMT, CMLDT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:GELLINGER
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:ANN
Other - Last Name:GELLINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT, CMLDT
Mailing Address - Street 1:1669 OAK ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-4747
Mailing Address - Country:US
Mailing Address - Phone:503-752-1458
Mailing Address - Fax:
Practice Address - Street 1:311 B AVE
Practice Address - Street 2:SUITE L
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3055
Practice Address - Country:US
Practice Address - Phone:503-752-1458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19296225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist