Provider Demographics
NPI: | 1659438406 |
---|---|
Name: | NEVILLE, CYNTHIA ELIZABETH (PT, DPT) |
Entity type: | Individual |
Prefix: | DR |
First Name: | CYNTHIA |
Middle Name: | ELIZABETH |
Last Name: | NEVILLE |
Suffix: | |
Gender: | F |
Credentials: | PT, DPT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 4500 SAN PABLO RD S |
Mailing Address - Street 2: | |
Mailing Address - City: | JACKSONVILLE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32224-1865 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 904-953-2000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4500 SAN PABLO RD S |
Practice Address - Street 2: | |
Practice Address - City: | JACKSONVILLE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32224-1865 |
Practice Address - Country: | US |
Practice Address - Phone: | 904-953-2000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-02 |
Last Update Date: | 2020-10-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 070014284 | 225100000X |
NJ | 40QA01559700 | 2251X0800X |
FL | PT6475 | 225100000X |
FL | 6475 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |