Provider Demographics
NPI:1619284478
Name:VALDEZ, CYNTHIA L (PTA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 W CAMINO PABLO DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-3129
Mailing Address - Country:US
Mailing Address - Phone:719-647-1145
Mailing Address - Fax:
Practice Address - Street 1:550 FRONTAGE RD
Practice Address - Street 2:SUITE 2415
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1202
Practice Address - Country:US
Practice Address - Phone:877-787-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant