Provider Demographics
NPI:1780383307
Name:SMOCK, CINDY M (MS, PT)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:M
Last Name:SMOCK
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:M
Other - Last Name:HOLZHAUSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:3224 NUGENT BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1608
Mailing Address - Country:US
Mailing Address - Phone:812-371-6643
Mailing Address - Fax:
Practice Address - Street 1:2400 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5351
Practice Address - Country:US
Practice Address - Phone:812-371-6643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006856A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist