Provider Demographics
NPI:1669598835
Name:AYCOCK, CYNTHIA LOU (DPT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOU
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CENTRAL AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3006
Mailing Address - Country:US
Mailing Address - Phone:304-237-5875
Mailing Address - Fax:
Practice Address - Street 1:422 23RD ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901
Practice Address - Country:US
Practice Address - Phone:304-469-2966
Practice Address - Fax:304-469-2674
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-07-27
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2009-07-27
Provider Licenses
StateLicense IDTaxonomies
WV002616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist