Provider Demographics
NPI:1598005001
Name:FULLER, CYNDI (RMT)
Entity Type:Individual
Prefix:
First Name:CYNDI
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 N FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1653
Mailing Address - Country:US
Mailing Address - Phone:303-956-2680
Mailing Address - Fax:
Practice Address - Street 1:1032 E SOUTH BOULDER RD
Practice Address - Street 2:ROOM 206
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2565
Practice Address - Country:US
Practice Address - Phone:303-956-2680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4198174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist