Provider Demographics
NPI:1548486467
Name:IRELAND, CYNTHIA DENISE (PT ASST)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DENISE
Last Name:IRELAND
Suffix:
Gender:F
Credentials:PT ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 N 76 ST
Mailing Address - Street 2:#2
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-5048
Mailing Address - Country:US
Mailing Address - Phone:414-546-7340
Mailing Address - Fax:
Practice Address - Street 1:3939 S 92 ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228
Practice Address - Country:US
Practice Address - Phone:414-546-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI746019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant