Provider Demographics
| NPI: | 1659438406 |
|---|---|
| Name: | NEVILLE, CYNTHIA ELIZABETH (PT, DPT) |
| Entity type: | Individual |
| Prefix: | DR |
| First Name: | CYNTHIA |
| Middle Name: | ELIZABETH |
| Last Name: | NEVILLE |
| Suffix: | |
| Gender: | F |
| Credentials: | PT, DPT |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 4500 SAN PABLO RD S |
| Mailing Address - Street 2: | |
| Mailing Address - City: | JACKSONVILLE |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 32224-1865 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 904-953-2000 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 4500 SAN PABLO RD S |
| Practice Address - Street 2: | |
| Practice Address - City: | JACKSONVILLE |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 32224-1865 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 904-953-2000 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2007-01-02 |
| Last Update Date: | 2020-10-12 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| IL | 070014284 | 225100000X |
| NJ | 40QA01559700 | 2251X0800X |
| FL | PT6475 | 225100000X |
| FL | 6475 | 225100000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |