Provider Demographics
NPI:1669764833
Name:LONG, CYNTHIA FLORY (PT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:FLORY
Last Name:LONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1846 SOUTHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-2468
Mailing Address - Country:US
Mailing Address - Phone:727-647-8186
Mailing Address - Fax:
Practice Address - Street 1:14141 46TH ST N STE 1202
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3860
Practice Address - Country:US
Practice Address - Phone:727-535-6746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL6504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist