Provider Demographics
NPI:1871743351
Name:LYCANS, CYNTHIA (PT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:LYCANS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 BETHEL RD
Mailing Address - Street 2:STE D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2467
Mailing Address - Country:US
Mailing Address - Phone:614-459-4714
Mailing Address - Fax:614-459-1637
Practice Address - Street 1:974 BETHEL RD
Practice Address - Street 2:STE D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2467
Practice Address - Country:US
Practice Address - Phone:614-459-4714
Practice Address - Fax:614-459-1637
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist