Provider Demographics
NPI:1346970027
Name:THOMAS-RUSTIN, CYNTHIA T
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:T
Last Name:THOMAS-RUSTIN
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 1:8613 ACKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2903
Mailing Address - Country:US
Mailing Address - Phone:804-306-5958
Mailing Address - Fax:
Practice Address - Street 1:8501 BROOK RD # A
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4019
Practice Address - Country:US
Practice Address - Phone:804-497-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist