Provider Demographics
NPI:1760438014
Name:LACK, CINDY LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:LEE
Last Name:LACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:LEE
Other - Last Name:LANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:60 ARMETALE LUSTER
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580
Mailing Address - Country:US
Mailing Address - Phone:585-670-9306
Mailing Address - Fax:
Practice Address - Street 1:1 WHIPPLE LANE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622
Practice Address - Country:US
Practice Address - Phone:585-338-3070
Practice Address - Fax:585-336-5014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0232021225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic