Provider Demographics
NPI:1376817692
Name:SYLVESTER, DONALD LENARD (ACMT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LENARD
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:ACMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-0441
Mailing Address - Country:US
Mailing Address - Phone:989-366-9148
Mailing Address - Fax:
Practice Address - Street 1:4532 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-9005
Practice Address - Country:US
Practice Address - Phone:989-366-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDIPLOMA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI584524OtherASSOCIATED BODYWORKERS & MASSAGE PROFESSIONALS