1821237934 NPI number — MRS. CYNTHIA RENEE WOOTERS P.T.

Table of content: MRS. CYNTHIA RENEE WOOTERS P.T. (NPI 1821237934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821237934 NPI number — MRS. CYNTHIA RENEE WOOTERS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOTERS
Provider First Name:
CYNTHIA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821237934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 N BRIGHTLEAF BLVD
Provider Second Line Business Mailing Address:
REHAB SERVICES DEPARTMENT
Provider Business Mailing Address City Name:
SMITHFIELD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27577-4407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-938-7296
Provider Business Mailing Address Fax Number:
919-938-7078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 N BRIGHTLEAF BLVD
Provider Second Line Business Practice Location Address:
REHAB SERVICES DEPARTMENT
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-938-7296
Provider Business Practice Location Address Fax Number:
919-938-7078
Provider Enumeration Date:
02/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2641 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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