Provider Demographics
NPI:1659511442
Name:PERKINS, CYNTHIA ROSE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ROSE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ROSE
Other - Last Name:GALUSHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 EVERTS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2040
Mailing Address - Country:US
Mailing Address - Phone:518-793-4700
Mailing Address - Fax:518-793-6325
Practice Address - Street 1:37 EVERTS AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12804-2040
Practice Address - Country:US
Practice Address - Phone:518-793-4700
Practice Address - Fax:518-793-6325
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0059551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist