Provider Demographics
NPI:1710650023
Name:WILLIAMS, CYNTHIA CHAITAH (LMT, ESTHETICIAN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:CHAITAH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT, ESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E CERVANTES ST # B228
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3286
Mailing Address - Country:US
Mailing Address - Phone:850-208-8253
Mailing Address - Fax:
Practice Address - Street 1:2800 N 9TH AVE APT 30B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-3694
Practice Address - Country:US
Practice Address - Phone:850-208-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66988225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty