Healthcare Provider Details

I. General information

NPI: 1205099348
Provider Name (Legal Business Name): CYNTHIA MARY HLAVAC MBA, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 S 16TH ST
MILWAUKEE WI
53215-4526
US

IV. Provider business mailing address

2525 S SHORE DR #16D
MILWAUKEE WI
53207-1973
US

V. Phone/Fax

Practice location:
  • Phone: 414-647-7422
  • Fax:
Mailing address:
  • Phone: 414-483-1823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5081024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: