Provider Demographics
NPI:1568439636
Name:KELLEY, CYNTHIA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:KELLEY
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 1:5301 E FRIESS DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2913
Mailing Address - Country:US
Mailing Address - Phone:602-368-9047
Mailing Address - Fax:
Practice Address - Street 1:402 E GREENWAY PKWY
Practice Address - Street 2:SUITE 12
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2350
Practice Address - Country:US
Practice Address - Phone:602-789-6878
Practice Address - Fax:602-789-6708
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist