MEDICARE: MRS. CYNTHIA M GROUP PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	237	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841235538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA M GROUP PT

Provider Business Mailing Address
First Line	:	49 INGLEWOOD CIR
Second Line	:
City	:	SAINT HELENA ISLAND
State	:	SC
Zip	:	29920-3609
Country	:	US
Telephone Number	:	843-838-0986
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 INGLEWOOD CIRCLE
Second Line	:
City	:	ST HELENA ISLAND
State	:	SC
Zip	:	29920-3609
Country	:	US
Telephone Number	:	803-300-4555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	07/08/2007

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