Provider Demographics
NPI:1366941197
Name:HAIR, CYNTHIA ANN (PTA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:HAIR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 YALE PL
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7086
Mailing Address - Country:US
Mailing Address - Phone:843-457-1160
Mailing Address - Fax:
Practice Address - Street 1:11931 PLAZA DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9356
Practice Address - Country:US
Practice Address - Phone:843-357-4039
Practice Address - Fax:843-357-4227
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3921225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant