Provider Demographics
NPI:1700409224
Name:FABIAN, CYNTHIA (LPTA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:FABIAN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 HEIDI PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2504
Mailing Address - Country:US
Mailing Address - Phone:334-333-4927
Mailing Address - Fax:
Practice Address - Street 1:629 AL HWY-21
Practice Address - Street 2:
Practice Address - City:HAYNEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36040
Practice Address - Country:US
Practice Address - Phone:334-548-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6773225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant