Provider Demographics
NPI:1811531445
Name:WISSOCKI, CYNTHIA WHITE (MPT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:WHITE
Last Name:WISSOCKI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10916 PARNU ST
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-1401
Mailing Address - Country:US
Mailing Address - Phone:239-572-0608
Mailing Address - Fax:
Practice Address - Street 1:6869 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-5320
Practice Address - Country:US
Practice Address - Phone:239-348-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist