Provider Demographics
NPI:1235858283
Name:CUSTER, SYDNEY (ATC)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29560 W LAKE MIOLA DR
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1396
Mailing Address - Country:US
Mailing Address - Phone:913-742-3238
Mailing Address - Fax:
Practice Address - Street 1:29560 W LAKE MIOLA DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1396
Practice Address - Country:US
Practice Address - Phone:913-742-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS20000525002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer