Provider Demographics
NPI:1750658605
Name:WHEELER, CYNTHIA LATHER (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LATHER
Last Name:WHEELER
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 1:273 COUNTY ROUTE 28B
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-3221
Mailing Address - Country:US
Mailing Address - Phone:518-937-5780
Mailing Address - Fax:
Practice Address - Street 1:1979 CENTRAL AVE
Practice Address - Street 2:C/O MAYWOOD SCHOOL
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4501
Practice Address - Country:US
Practice Address - Phone:518-464-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist