Provider Demographics
NPI:1093593261
Name:SYDNOR, MARYAH D (PT)
Entity Type:Individual
Prefix:
First Name:MARYAH
Middle Name:D
Last Name:SYDNOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-3800
Mailing Address - Country:US
Mailing Address - Phone:540-639-5786
Mailing Address - Fax:540-639-5786
Practice Address - Street 1:1200 TYLER AVE
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-3800
Practice Address - Country:US
Practice Address - Phone:540-639-5786
Practice Address - Fax:540-639-5786
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist