Provider Demographics
NPI:1952500548
Name:PESCO, CYNTHIA BRAGG (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:BRAGG
Last Name:PESCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:BRAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2170 W IRONWOOD CENTER DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2606
Mailing Address - Country:US
Mailing Address - Phone:208-677-1988
Mailing Address - Fax:
Practice Address - Street 1:2170 W IRONWOOD CENTER DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2606
Practice Address - Country:US
Practice Address - Phone:208-677-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7566225100000X
IDPT5418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist