Provider Demographics
NPI:1952452013
Name:RANKIN, CYNTHIA J (P T)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:RANKIN
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 W SUD PKWY
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7482
Mailing Address - Country:US
Mailing Address - Phone:309-693-9189
Mailing Address - Fax:309-693-9946
Practice Address - Street 1:2338 W SUD PKWY
Practice Address - Street 2:SUITE 3100
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7482
Practice Address - Country:US
Practice Address - Phone:309-693-9189
Practice Address - Fax:309-693-9946
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK01574Medicare PIN