Individual
MRS. CYNTHIA THIEBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
318 MORGAN ST, TONAWANDA, NY 14150-2027
(716) 693-1401
Mailing address
318 MORGAN ST, TONAWANDA, NY 14150-2027
(716) 693-1401
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17
OTHER SERVICE PROVIDER
NY
Enumeration date
06/14/2012
Last updated
06/14/2012
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