Provider Demographics
NPI:1912631565
Name:MICHEL, CYNTHIA LYNETTE
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNETTE
Last Name:MICHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 LIGHTHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1436
Mailing Address - Country:US
Mailing Address - Phone:630-886-0188
Mailing Address - Fax:
Practice Address - Street 1:2500 175TH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1801
Practice Address - Country:US
Practice Address - Phone:708-474-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.007782225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant