Provider Demographics
NPI:1467745745
Name:JACOBS, CYNTHIA JEAN
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JEAN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:JEAN
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:782 RTE 7A
Mailing Address - Street 2:CYNTHIA JACOBS
Mailing Address - City:SHAFTSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05262
Mailing Address - Country:US
Mailing Address - Phone:802-442-6228
Mailing Address - Fax:
Practice Address - Street 1:782 RTE 7A
Practice Address - Street 2:CYNTHIA JACOBS
Practice Address - City:SHAFTSBURY
Practice Address - State:VT
Practice Address - Zip Code:05262
Practice Address - Country:US
Practice Address - Phone:802-442-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist