Provider Demographics
NPI:1740314251
Name:FUDMAN, CINDY (PT)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:
Last Name:FUDMAN
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 1:1490 E WHITESTONE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2274
Mailing Address - Country:US
Mailing Address - Phone:512-260-3300
Mailing Address - Fax:512-260-3343
Practice Address - Street 1:1490 E WHITESTONE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2274
Practice Address - Country:US
Practice Address - Phone:512-260-3300
Practice Address - Fax:512-260-3343
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10446672251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8T0814OtherBCBS PROVIDER #