Provider Demographics
NPI:1811001589
Name:CWYNAR, DAVID A (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:CWYNAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 B DR N
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-8420
Mailing Address - Country:US
Mailing Address - Phone:517-630-0267
Mailing Address - Fax:517-630-0271
Practice Address - Street 1:300 B DR N
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-8420
Practice Address - Country:US
Practice Address - Phone:517-630-0267
Practice Address - Fax:517-630-0271
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501010382OtherPT LIC
MI5501010382OtherPT LIC