Provider Demographics
NPI:1720446149
Name:BRANSON, CYNTHIA (LMT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BRANSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CYNDI
Other - Middle Name:BELLA
Other - Last Name:BRANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3219 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25015-1059
Mailing Address - Country:US
Mailing Address - Phone:304-767-5601
Mailing Address - Fax:
Practice Address - Street 1:501 1/2 50TH ST SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2023
Practice Address - Country:US
Practice Address - Phone:304-767-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2014-3209225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist