MEDICARE: MS. CYNTHIA MAGELNICKI PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA19251	FL

General Provider Information

NPI Number	:	1083098776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA MAGELNICKI PTA

Provider Business Mailing Address
First Line	:	563 SPRINGDALE CIR
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-1533
Country	:	US
Telephone Number	:	321-917-1609
Fax Number	:

Provider Business Practice Location Address
First Line	:	563 SPRINGDALE CIR
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-1533
Country	:	US
Telephone Number	:	321-917-1609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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