Provider Demographics
NPI:1750322889
Name:ANGEL, CYNTHIA DEAREN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DEAREN
Last Name:ANGEL
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 1:1305 HANDY RD
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-8789
Mailing Address - Country:US
Mailing Address - Phone:859-613-4124
Mailing Address - Fax:
Practice Address - Street 1:1305 HANDY RD
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-8789
Practice Address - Country:US
Practice Address - Phone:859-613-4124
Practice Address - Fax:859-748-6006
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0014022251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics