Provider Demographics
NPI:1205025012
Name:COCHRAN, CYNTHIA LOU (PT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LOU
Last Name:COCHRAN
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 1:111 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4636
Mailing Address - Country:US
Mailing Address - Phone:308-635-2019
Mailing Address - Fax:
Practice Address - Street 1:111 W 36TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4636
Practice Address - Country:US
Practice Address - Phone:308-635-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE954225100000X
CO9069225100000X
WY512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist