Healthcare Provider Details

I. General information

NPI: 1114985751
Provider Name (Legal Business Name): CYNTHIA M FLEENER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 4TH STREET A
EAST MOLINE IL
61244-3442
US

IV. Provider business mailing address

4029 4TH STREET A
EAST MOLINE IL
61244-3442
US

V. Phone/Fax

Practice location:
  • Phone: 309-737-2542
  • Fax:
Mailing address:
  • Phone: 309-737-2542
  • Fax: 309-743-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03446
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: