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General NPI Number Information
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NPI Number | 1295765303
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Entity Type | Individual
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Provider Name | CYNTHIA ELAINE AHLHOLM PT MS OCS
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 2601 OCEAN PARK BLVD STE 302
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City | SANTA MONICA
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State | CA
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Zip | 90405-5215
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Country | US
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Telephone | 310-913-8480
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Fax |
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Provider Business Mailing Address
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Address Line | 11425 ROCHESTER AVE APT 19
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 310-477-0647
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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 | PT22538
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License Number State | CA
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