Provider Demographics
NPI:1649579723
Name:SY, AILEEN M (PT)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:M
Last Name:SY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51738 SAGECREST DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6887
Mailing Address - Country:US
Mailing Address - Phone:574-339-5959
Mailing Address - Fax:574-273-1137
Practice Address - Street 1:51738 SAGECREST DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-6887
Practice Address - Country:US
Practice Address - Phone:574-339-5959
Practice Address - Fax:574-273-1137
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007853A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist