Provider Demographics
NPI:1083928907
Name:SYLVESTER, GARY R (MS, PT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:303 US ROUTE 1
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-7029
Mailing Address - Country:US
Mailing Address - Phone:207-865-0004
Mailing Address - Fax:207-865-3004
Practice Address - Street 1:303 US ROUTE 1
Practice Address - Street 2:SUITE 1B
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-7029
Practice Address - Country:US
Practice Address - Phone:207-865-0004
Practice Address - Fax:207-865-3004
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPT2761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist