Provider Demographics
NPI:1114253895
Name:DEZARN, CINDY (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:
Last Name:DEZARN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CEDARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-4096
Mailing Address - Country:US
Mailing Address - Phone:606-599-0969
Mailing Address - Fax:
Practice Address - Street 1:376 MANCHESTER SQUARE SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-4096
Practice Address - Country:US
Practice Address - Phone:606-598-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist