Healthcare Provider Details

I. General information

NPI: 1770660516
Provider Name (Legal Business Name): CYNTHIA WITHROW RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 S CALUMET RD STE 3
CHESTERTON IN
46304-2389
US

IV. Provider business mailing address

1595 S CALUMET RD STE 3
CHESTERTON IN
46304-2389
US

V. Phone/Fax

Practice location:
  • Phone: 219-764-4888
  • Fax: 219-898-4258
Mailing address:
  • Phone: 219-764-4888
  • Fax: 219-898-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05002214A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: