Provider Demographics
NPI:1093231698
Name:PETERS, SYDNEY F (PT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:F
Last Name:PETERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:F
Other - Last Name:FERRYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:200 NE MOTHER JOSEPH PL STE 210
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3295
Mailing Address - Country:US
Mailing Address - Phone:360-254-6161
Mailing Address - Fax:360-449-1146
Practice Address - Street 1:55 S 47TH AVE STE 111
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-7779
Practice Address - Country:US
Practice Address - Phone:360-254-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60763478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist