Provider Demographics
NPI:1114054863
Name:RIECK, CYNTHIA L (PT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:L
Last Name:RIECK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31170 GOVERMENT DR
Mailing Address - Street 2:PO BOX 331
Mailing Address - City:PEQUOT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56472-1001
Mailing Address - Country:US
Mailing Address - Phone:218-568-5666
Mailing Address - Fax:218-568-5466
Practice Address - Street 1:31170 GOVERMENT DR
Practice Address - Street 2:
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472-1001
Practice Address - Country:US
Practice Address - Phone:218-568-5666
Practice Address - Fax:218-568-5466
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1982261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy