Provider Demographics
NPI:1942393293
Name:HABERMAN, CYNTHIA D (PTA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:HABERMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MONROE ST
Mailing Address - Street 2:APT 9
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5882
Mailing Address - Country:US
Mailing Address - Phone:408-506-9941
Mailing Address - Fax:
Practice Address - Street 1:166 MONROE ST
Practice Address - Street 2:APT 9
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5882
Practice Address - Country:US
Practice Address - Phone:408-506-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8098225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant