Provider Demographics
NPI:1578101945
Name:GILLETTE, CYNTHIA MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MICHELE
Last Name:GILLETTE
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 1:6374 E SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-8554
Mailing Address - Country:US
Mailing Address - Phone:315-492-4940
Mailing Address - Fax:
Practice Address - Street 1:739 IRVING AVE STE 610
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1651
Practice Address - Country:US
Practice Address - Phone:315-470-7531
Practice Address - Fax:315-470-2733
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist