Provider Demographics
NPI:1609041201
Name:LAZZARETTI, CYNTHIA LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:LAZZARETTI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:CAPITAN
Mailing Address - State:NM
Mailing Address - Zip Code:88316-0813
Mailing Address - Country:US
Mailing Address - Phone:575-354-0686
Mailing Address - Fax:
Practice Address - Street 1:145 INDIAN DIVIDE ROAD
Practice Address - Street 2:
Practice Address - City:CAPITAN
Practice Address - State:NM
Practice Address - Zip Code:88316-0813
Practice Address - Country:US
Practice Address - Phone:575-354-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4903172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist