Provider Demographics
NPI:1346863982
Name:CLARKE, CYNTHIA (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CLARKE
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 1:6153 FULLER CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2541
Mailing Address - Country:US
Mailing Address - Phone:703-924-1414
Mailing Address - Fax:703-924-1114
Practice Address - Street 1:6153 FULLER CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2541
Practice Address - Country:US
Practice Address - Phone:703-924-1414
Practice Address - Fax:703-924-1114
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist