Provider Demographics
NPI:1205614146
Name:CARNEAL, CYNTHIA (PTA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CARNEAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:408 RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:KILMICHAEL
Mailing Address - State:MS
Mailing Address - Zip Code:39747-9756
Mailing Address - Country:US
Mailing Address - Phone:903-249-0995
Mailing Address - Fax:
Practice Address - Street 1:627 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-2021
Practice Address - Country:US
Practice Address - Phone:662-845-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA7498225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant