Provider Demographics
NPI:1790870921
Name:SEWALL, CYNTHIA MARIE (MMSCPT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:SEWALL
Suffix:
Gender:F
Credentials:MMSCPT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:MARIE
Other - Last Name:BARBISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMSCPT
Mailing Address - Street 1:420 BAINBRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1568
Mailing Address - Country:US
Mailing Address - Phone:215-629-3837
Mailing Address - Fax:215-629-5531
Practice Address - Street 1:420 BAINBRIDGE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1568
Practice Address - Country:US
Practice Address - Phone:215-629-3837
Practice Address - Fax:215-629-5531
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104612SAVMedicare PIN