Provider Demographics
NPI:1245526193
Name:YETTER, CYNTHIA LEE (LMT)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LEE
Last Name:YETTER
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:PO BOX 620669
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32762-0669
Mailing Address - Country:US
Mailing Address - Phone:407-529-7761
Mailing Address - Fax:
Practice Address - Street 1:470 N PINE AVE
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9715
Practice Address - Country:US
Practice Address - Phone:407-529-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 16203225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist