Provider Demographics
NPI:1487360053
Name:SUGANOB, CYNYRLYNNE LOLA (PT, DPT)
Entity type:Individual
Prefix:
First Name:CYNYRLYNNE
Middle Name:LOLA
Last Name:SUGANOB
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 1:1455 W WESTWIND CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-8926
Mailing Address - Country:US
Mailing Address - Phone:812-259-1442
Mailing Address - Fax:
Practice Address - Street 1:1332 W ARCH HAVEN AVE STE E
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2078
Practice Address - Country:US
Practice Address - Phone:812-333-7018
Practice Address - Fax:812-333-7094
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012864A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist