Provider Demographics
NPI:1598728669
Name:SICILIANO, LYNN ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ELIZABETH
Last Name:SICILIANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:ELIZABETH
Other - Last Name:GORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24168 ROCKFORD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-565-4726
Mailing Address - Fax:
Practice Address - Street 1:23550 PARK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-720-0136
Practice Address - Fax:313-724-0142
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist