Provider Demographics
NPI:1265620629
Name:TUSCANO, CYNTHIA D (PT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:TUSCANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 MILSTEAD RD NE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3838
Mailing Address - Country:US
Mailing Address - Phone:770-908-0665
Mailing Address - Fax:770-938-3088
Practice Address - Street 1:1841 MONTREAL RD
Practice Address - Street 2:SUITE 216
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5712
Practice Address - Country:US
Practice Address - Phone:770-908-0665
Practice Address - Fax:770-938-3088
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002264225100000X
GAPT009304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist