Provider Demographics
NPI:1326015710
Name:OLIVACZ, CYNTHIA MATHEWSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MATHEWSON
Last Name:OLIVACZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:LEE
Other - Last Name:MATHEWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:701 REVOLUTION ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3321
Mailing Address - Country:US
Mailing Address - Phone:410-939-4334
Mailing Address - Fax:410-939-0530
Practice Address - Street 1:701 REVOLUTION ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3321
Practice Address - Country:US
Practice Address - Phone:410-939-4334
Practice Address - Fax:410-939-0530
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist