Provider Demographics
NPI:1679829774
Name:FROST, CYNTHIA RENEE
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:RENEE
Last Name:FROST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11326 HOLLOW TREE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9272
Mailing Address - Country:US
Mailing Address - Phone:909-244-0685
Mailing Address - Fax:909-244-0685
Practice Address - Street 1:11326 HOLLOW TREE DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-9272
Practice Address - Country:US
Practice Address - Phone:909-244-0685
Practice Address - Fax:909-244-0685
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT-4006225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant