Provider Demographics
NPI:1093573453
Name:THOMAS, CYNTHIA DEL CARMEN
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DEL CARMEN
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 1:3852 VIRGINIA BEACH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2489
Mailing Address - Country:US
Mailing Address - Phone:757-402-3092
Mailing Address - Fax:
Practice Address - Street 1:3852 VIRGINIA BEACH BLVD STE B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2489
Practice Address - Country:US
Practice Address - Phone:757-402-3092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019019112225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist