Individual
CYNTHIA TINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
628 CONGDON STREET, MIDDLETOWN, CT 06457
(860) 347-7144
Mailing address
913 LONG HILL ROAD, MIDDLETOWN, CT 06457
(203) 715-0014
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
000568
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000568
CONNECTICUT LICENSE
CT
Enumeration date
09/04/2017
Last updated
09/04/2017
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