Provider Demographics
NPI:1598122129
Name:ANDERSON, CYNTHIA LUANNE (LPTA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LUANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LUANNE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:56 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3826
Mailing Address - Country:US
Mailing Address - Phone:269-425-8576
Mailing Address - Fax:
Practice Address - Street 1:56 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3826
Practice Address - Country:US
Practice Address - Phone:269-425-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004693225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant