Provider Demographics
NPI:1760096432
Name:CYRWUS, JOHNATHAN ALLEN (LMT)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:ALLEN
Last Name:CYRWUS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 SE 8TH AVE APT 207D
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-7242
Mailing Address - Country:US
Mailing Address - Phone:305-395-2034
Mailing Address - Fax:
Practice Address - Street 1:1427 SE 8TH AVE APT 207D
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-7242
Practice Address - Country:US
Practice Address - Phone:305-395-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA86543225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist