Healthcare Provider Details

I. General information

NPI: 1619365335
Provider Name (Legal Business Name): CINDY OBRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 CARMICHAEL WAY
CARMICHAEL CA
95608-5314
US

IV. Provider business mailing address

1718 ALABAMA AVE
WEST SACRAMENTO CA
95691-4106
US

V. Phone/Fax

Practice location:
  • Phone: 916-483-2540
  • Fax:
Mailing address:
  • Phone: 916-373-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberAT6190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: