Provider Demographics
NPI:1689939803
Name:SYRETT, EDWARD D (DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
Last Name:SYRETT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 ATLEE RD STE D
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1815
Mailing Address - Country:US
Mailing Address - Phone:804-569-1787
Mailing Address - Fax:804-569-9787
Practice Address - Street 1:8201 ATLEE RD STE D
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-569-1787
Practice Address - Fax:804-569-9787
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist