Provider Demographics
NPI:1134432263
Name:CYR, RANDY KENNETH JR (PT)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:KENNETH
Last Name:CYR
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BENNOCH RD
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3620
Mailing Address - Country:US
Mailing Address - Phone:207-827-7487
Mailing Address - Fax:207-866-3821
Practice Address - Street 1:117 BENNOCH RD
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3620
Practice Address - Country:US
Practice Address - Phone:207-827-7487
Practice Address - Fax:207-866-3821
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist