Provider Demographics
NPI:1417167875
Name:CONSTABLE, SYLVIA R (LMT)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:R
Last Name:CONSTABLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 ISLE OF PNES
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2010
Mailing Address - Country:US
Mailing Address - Phone:315-638-7837
Mailing Address - Fax:
Practice Address - Street 1:918 OLD LIVERPOOL RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5513
Practice Address - Country:US
Practice Address - Phone:315-243-9124
Practice Address - Fax:315-451-0200
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015499225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist