Provider Demographics
NPI:1669814398
Name:MUMM, CYNTHIA (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MUMM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 REITE AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1407
Mailing Address - Country:US
Mailing Address - Phone:515-277-3299
Mailing Address - Fax:
Practice Address - Street 1:1454 30TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1305
Practice Address - Country:US
Practice Address - Phone:515-223-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist