Provider Demographics
NPI:1902965700
Name:PASTUHOV, CYNTHIA MORGAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MORGAN
Last Name:PASTUHOV
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 171
Mailing Address - Street 2:
Mailing Address - City:STOCKTON SPRINGS
Mailing Address - State:ME
Mailing Address - Zip Code:04981-0171
Mailing Address - Country:US
Mailing Address - Phone:207-567-3772
Mailing Address - Fax:
Practice Address - Street 1:10 MAYO ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6052
Practice Address - Country:US
Practice Address - Phone:207-338-0184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT 609225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist