Provider Demographics
NPI:1790870921
Name:SEWALL, CYNTHIA MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:MARIE
Last Name:SEWALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:MARIE
Other - Last Name:BARBISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMSCPT
Mailing Address - Street 1:1550 N MILFORD RD STE 203B
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1058
Mailing Address - Country:US
Mailing Address - Phone:248-685-9623
Mailing Address - Fax:248-684-0594
Practice Address - Street 1:1550 N MILFORD RD STE 203B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1058
Practice Address - Country:US
Practice Address - Phone:248-685-9623
Practice Address - Fax:248-684-0594
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002875225100000X
PAPT016644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104612SAVMedicare PIN