Provider Demographics
NPI:1689639155
Name:GRUDZINSKI, CYNTHIA SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:SUE
Last Name:GRUDZINSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:S
Other - Last Name:KORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N1412 POPLAR GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098
Mailing Address - Country:US
Mailing Address - Phone:920-925-3122
Mailing Address - Fax:920-925-3122
Practice Address - Street 1:600 EAST MAIN
Practice Address - Street 2:SUITE 200 KELLY LYNCH PHYSICAL THERAPY
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094
Practice Address - Country:US
Practice Address - Phone:920-206-1000
Practice Address - Fax:920-206-1010
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6543024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist