Healthcare Provider Details

I. General information

NPI: 1841235538
Provider Name (Legal Business Name): CYNTHIA M GROUP PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 INGLEWOOD CIRCLE
ST HELENA ISLAND SC
29920-3609
US

IV. Provider business mailing address

49 INGLEWOOD CIR
SAINT HELENA ISLAND SC
29920-3609
US

V. Phone/Fax

Practice location:
  • Phone: 803-300-4555
  • Fax:
Mailing address:
  • Phone: 843-838-0986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number237
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: