Provider Demographics
NPI:1649599432
Name:SYKORA, RUTH G (LMT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:G
Last Name:SYKORA
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 1:1064 GARDNER ROAD
Mailing Address - Street 2:CENTER FOR THERAPEUTIC MASSAGE
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:843-852-9939
Mailing Address - Fax:
Practice Address - Street 1:45 COURTENAY DRIVE
Practice Address - Street 2:CENTER FOR THERAPUETIC MASSAGE
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401
Practice Address - Country:US
Practice Address - Phone:843-425-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist