Provider Demographics
NPI:1376938324
Name:HUBERT, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HUBERT
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 1:9142 W KEN CARYL AVE
Mailing Address - Street 2:D2
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-5252
Mailing Address - Country:US
Mailing Address - Phone:303-933-6153
Mailing Address - Fax:303-933-9431
Practice Address - Street 1:9142 W KEN CARYL AVE
Practice Address - Street 2:D2
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-5252
Practice Address - Country:US
Practice Address - Phone:303-933-6153
Practice Address - Fax:303-933-9431
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12732225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12732OtherSTATE OF COLORADO DORA