Provider Demographics
NPI:1073094173
Name:THOMAS, CYNTORIA DE'ASIA
Entity Type:Individual
Prefix:MISS
First Name:CYNTORIA
Middle Name:DE'ASIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 STATESBORO PLACE CIR APT CC559
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0232
Mailing Address - Country:US
Mailing Address - Phone:478-357-6027
Mailing Address - Fax:
Practice Address - Street 1:1400 STATESBORO PLACE CIR APT CC559
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0232
Practice Address - Country:US
Practice Address - Phone:478-357-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer