Basic Information
Provider Information
NPI: 1003003740
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAILLANT
FirstName: CINDY
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: MFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1401 S FEDERAL HWY
Address2:  
City: FT LAUDERDALE
State: FL
PostalCode: 333162619
CountryCode: US
TelephoneNumber: 9547281129
FaxNumber:  
Practice Location
Address1: 1401 S FEDERAL HWY
Address2:  
City: FT LAUDERDALE
State: FL
PostalCode: 333162619
CountryCode: US
TelephoneNumber: 9547281129
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/26/2007
LastUpdateDate: 09/26/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
222Q00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist 

No ID Information.


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