Provider Demographics
NPI:1346348521
Name:MOONEYHAM, CYNTHIA K (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:K
Last Name:MOONEYHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:K
Other - Last Name:MOONEYHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:13369 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050
Mailing Address - Country:US
Mailing Address - Phone:305-289-9950
Mailing Address - Fax:305-289-9913
Practice Address - Street 1:2357 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2231
Practice Address - Country:US
Practice Address - Phone:305-289-8270
Practice Address - Fax:305-289-8283
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist