Provider Demographics
NPI:1639372287
Name:RICHARDS, CINDY K (PT, OCS, MTC, MBA)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:K
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PT, OCS, MTC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 KENNESAW AVE.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9406
Mailing Address - Country:US
Mailing Address - Phone:770-425-4205
Mailing Address - Fax:770-425-4247
Practice Address - Street 1:732 KENNESAW AVE.
Practice Address - Street 2:STE 120
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9406
Practice Address - Country:US
Practice Address - Phone:770-425-4205
Practice Address - Fax:770-425-4247
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS67502Medicare UPIN
GA65BBBBTMedicare ID - Type Unspecified