Provider Demographics
NPI:1538426648
Name:HACK, CYNTHIA ANN (PTA)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:HACK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630
Mailing Address - Country:US
Mailing Address - Phone:828-396-2387
Mailing Address - Fax:828-396-9578
Practice Address - Street 1:100 SUNSET ST.
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630
Practice Address - Country:US
Practice Address - Phone:828-396-2387
Practice Address - Fax:828-396-9578
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4606225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant