Provider Demographics
NPI:1639316409
Name:CYNTHELESE ENTERPRISES, LLC
Entity Type:Organization
Organization Name:CYNTHELESE ENTERPRISES, LLC
Other - Org Name:CYNTHELESE MASSAGE SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHYANN
Authorized Official - Middle Name:CYNTHELESE
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:713-694-1772
Mailing Address - Street 1:10133 IRVINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4412
Mailing Address - Country:US
Mailing Address - Phone:713-694-1772
Mailing Address - Fax:
Practice Address - Street 1:10133 IRVINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4412
Practice Address - Country:US
Practice Address - Phone:713-694-1772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT034925225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty