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General NPI Number Information
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NPI Number | 1194915215
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Entity Type | Individual
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Provider Name | CYNTHIA A SISULAK PT
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Gender | Female
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 14055 TOWN LOOP BLVD 300
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City | ORLANDO
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State | FL
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Zip | 32837-6106
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Country | US
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Telephone | 262-720-5855
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Fax |
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Provider Business Mailing Address
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Address Line | 17532 HILLSIDE DR
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City | MONTVERDE
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State | FL
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Zip | 34756-3184
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Country | US
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Telephone | 262-720-5855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30463
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License Number State | FL
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