Provider Demographics
NPI:1144288648
Name:MARSHALL, CYNTHIA LYNN (PT)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:16 FOREST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8717
Mailing Address - Country:US
Mailing Address - Phone:802-388-9541
Mailing Address - Fax:802-388-2334
Practice Address - Street 1:175 WILSON RD STE 101
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8858
Practice Address - Country:US
Practice Address - Phone:802-388-3533
Practice Address - Fax:802-388-2334
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002876225100000X
CAPT12288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT28901OtherBCBS
VT43V055OtherMVP
VT28901OtherBCBS