Provider Demographics
NPI:1447561196
Name:HARDIN-WEISS, CYNTHIA S (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:S
Last Name:HARDIN-WEISS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:S
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:252 PEORIA LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3583
Mailing Address - Country:US
Mailing Address - Phone:618-206-8401
Mailing Address - Fax:
Practice Address - Street 1:252 PEORIA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3583
Practice Address - Country:US
Practice Address - Phone:618-206-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist