Provider Demographics
NPI:1841235538
Name:GROUP, CYNTHIA M (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:M
Last Name:GROUP
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 1:49 INGLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920-3609
Mailing Address - Country:US
Mailing Address - Phone:843-838-0986
Mailing Address - Fax:
Practice Address - Street 1:49 INGLEWOOD CIRCLE
Practice Address - Street 2:
Practice Address - City:ST HELENA ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29920-3609
Practice Address - Country:US
Practice Address - Phone:803-300-4555
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2372251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0016Medicaid