Provider Demographics
NPI:1306275565
Name:BENNETT, CYNTHIA (LMT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:HUDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:13616 BRIARCREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-4667
Mailing Address - Country:US
Mailing Address - Phone:512-653-7638
Mailing Address - Fax:
Practice Address - Street 1:12636 RESEARCH BLVD
Practice Address - Street 2:STE C206
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2200
Practice Address - Country:US
Practice Address - Phone:512-653-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT101610225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist