Provider Demographics
NPI:1710466008
Name:AGENA, CYAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CYAN
Middle Name:
Last Name:AGENA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-200-3620
Mailing Address - Fax:
Practice Address - Street 1:27699 JEFFERSON AVE STE 202
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2697
Practice Address - Country:US
Practice Address - Phone:951-506-1405
Practice Address - Fax:951-506-1406
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist