Provider Demographics
NPI:1790761146
Name:GARNER, CY LYNN (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:CY
Middle Name:LYNN
Last Name:GARNER
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11485 W TEMPE LN
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5093
Mailing Address - Country:US
Mailing Address - Phone:208-484-0805
Mailing Address - Fax:
Practice Address - Street 1:825 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-3528
Practice Address - Country:US
Practice Address - Phone:208-365-4400
Practice Address - Fax:208-365-4384
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-2672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer