Provider Demographics
NPI:1356887442
Name:RAYMOND, CYNTHIA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 ACADEMY RD
Mailing Address - Street 2:UNIT N
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1137
Mailing Address - Country:US
Mailing Address - Phone:215-743-4435
Mailing Address - Fax:215-743-8750
Practice Address - Street 1:10501 ACADEMY RD
Practice Address - Street 2:UNIT N
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1137
Practice Address - Country:US
Practice Address - Phone:215-743-4435
Practice Address - Fax:215-743-8750
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00588500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist