Provider Demographics
NPI:1457447476
Name:FOLTS, SYDNEY LYND (LMT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LYND
Last Name:FOLTS
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 1:1958 SE 27TH AVE
Mailing Address - Street 2:LOWER UNIT
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4963
Mailing Address - Country:US
Mailing Address - Phone:971-285-3196
Mailing Address - Fax:
Practice Address - Street 1:1330 SE 39TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4322
Practice Address - Country:US
Practice Address - Phone:503-232-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12948174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR12948OtherOREGON MASSAGE LICENSE
WAMA00019521OtherWA MASSAGE LICENSE