Provider Demographics
NPI:1487285706
Name:DORT, CYNTHIA LOUISE (LMT,BCTMB)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:DORT
Suffix:
Gender:F
Credentials:LMT,BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 GORNICK AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1775
Mailing Address - Country:US
Mailing Address - Phone:989-705-1451
Mailing Address - Fax:
Practice Address - Street 1:1029 GORNICK AVE STE 103
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1775
Practice Address - Country:US
Practice Address - Phone:989-705-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist