Healthcare Provider Details

I. General information

NPI: 1497957708
Provider Name (Legal Business Name): CYNTHIA ANNE MACKEY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA ANNE BROWN OT

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 GOLDEN GATE PKWY
NAPLES FL
34116-7459
US

IV. Provider business mailing address

15130 SUMMIT PLACE CIR
NAPLES FL
34119-4107
US

V. Phone/Fax

Practice location:
  • Phone: 239-455-9525
  • Fax: 239-455-2844
Mailing address:
  • Phone: 239-248-7873
  • Fax: 239-348-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberOT 11025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: