Healthcare Provider Details

I. General information

NPI: 1659581312
Provider Name (Legal Business Name): CINDY DENNIS MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N TUSTIN AVE
SANTA ANA CA
92705-3502
US

IV. Provider business mailing address

207 VENICE AVE. #2B
HUNTINGTON BEACH CA
92648-2880
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-3500
  • Fax:
Mailing address:
  • Phone: 714-849-2306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: