Provider Demographics
NPI:1821475690
Name:COX, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15224 MAIN ST
Mailing Address - Street 2:303
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7316
Mailing Address - Country:US
Mailing Address - Phone:425-357-1105
Mailing Address - Fax:425-379-9771
Practice Address - Street 1:15224 MAIN ST
Practice Address - Street 2:303
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-7316
Practice Address - Country:US
Practice Address - Phone:425-357-1105
Practice Address - Fax:425-379-9771
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00016567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist