Provider Demographics
NPI:1982900882
Name:FORTUNE, CYNTHIA J (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:J
Other - Last Name:JOHNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1020 11TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-2130
Mailing Address - Country:US
Mailing Address - Phone:812-547-7770
Mailing Address - Fax:812-547-7784
Practice Address - Street 1:1020 11TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2130
Practice Address - Country:US
Practice Address - Phone:812-547-7770
Practice Address - Fax:812-547-7784
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003826A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05003826AOtherPHYSICAL THERAPY LICENSE