Provider Demographics
NPI:1639458714
Name:FINE, CYNDI S (CBW)
Entity Type:Individual
Prefix:MS
First Name:CYNDI
Middle Name:S
Last Name:FINE
Suffix:
Gender:F
Credentials:CBW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6441 ENTERPRISE LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6441 ENTERPRISE LN
Practice Address - Street 2:SUITE 202
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1139
Practice Address - Country:US
Practice Address - Phone:608-446-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1226-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist