Provider Demographics
NPI:1073231296
Name:SUNNERBERG, SYDNEY FALLON (DPT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:FALLON
Last Name:SUNNERBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 LIONS MOUTH RD
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-5318
Mailing Address - Country:US
Mailing Address - Phone:978-270-9748
Mailing Address - Fax:
Practice Address - Street 1:145 WARD HILL AVE
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01835-6928
Practice Address - Country:US
Practice Address - Phone:978-372-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist