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General NPI Number Information
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NPI Number | 1346970027
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Entity Type | Individual
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Provider Name | CYNTHIA T THOMAS-RUSTIN
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Gender | Female
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 8501 BROOK RD # A
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City | GLEN ALLEN
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State | VA
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Zip | 23060-4019
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Country | US
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Telephone | 804-497-7417
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Fax |
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Provider Business Mailing Address
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Address Line | 8613 ACKLEY AVE
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City | HENRICO
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State | VA
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Zip | 23228-2903
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Country | US
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Telephone | 804-306-5958
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number |
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License Number State |
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