Provider Demographics
NPI:1578737748
Name:MATTHIESEN, CINDY LEE (PT)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LEE
Last Name:MATTHIESEN
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 1:1505 E STEVE OWENS BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-7917
Mailing Address - Country:US
Mailing Address - Phone:918-542-4101
Mailing Address - Fax:
Practice Address - Street 1:1505 E STEVE OWENS BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-7917
Practice Address - Country:US
Practice Address - Phone:918-542-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist