Provider Demographics
NPI:1679659353
Name:PETERSON, CYNTHIA SANDQUIST (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SANDQUIST
Last Name:PETERSON
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 1:6600 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1520
Mailing Address - Country:US
Mailing Address - Phone:913-451-7372
Mailing Address - Fax:913-451-7375
Practice Address - Street 1:6600 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1520
Practice Address - Country:US
Practice Address - Phone:913-451-7372
Practice Address - Fax:913-451-7375
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03673225100000X
MO2006038289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS37719018OtherBCBS
KS37719018OtherBCBS