Provider Demographics
NPI:1558330340
Name:GIANGRECO, CYNTHIA ANN (RPT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:GIANGRECO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 N PONDEROSA DR
Mailing Address - Street 2:STE. A109
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2375
Mailing Address - Country:US
Mailing Address - Phone:805-484-9199
Mailing Address - Fax:805-484-1711
Practice Address - Street 1:2460 N PONDEROSA DR
Practice Address - Street 2:STE. A109
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2375
Practice Address - Country:US
Practice Address - Phone:805-484-9199
Practice Address - Fax:805-484-1711
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT22198Medicare ID - Type UnspecifiedCYNTHIA GIANGRECO, R.P.T.