Provider Demographics
NPI:1710551320
Name:EKLUND, CYNTHIA ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANNE
Last Name:EKLUND
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 1:12343 HUNTERS CHASE DR APT 1511
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7220
Mailing Address - Country:US
Mailing Address - Phone:512-755-4389
Mailing Address - Fax:
Practice Address - Street 1:14028 N HWY 183 STE D-120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5992
Practice Address - Country:US
Practice Address - Phone:512-250-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT134246225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty