Provider Demographics
NPI:1720209356
Name:WEBB, SYDNEY LIANE (MT)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:LIANE
Last Name:WEBB
Suffix:
Gender:F
Credentials:MT
Other - Prefix:MS
Other - First Name:SYDNEY
Other - Middle Name:LIANE
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 3600
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-3600
Mailing Address - Country:US
Mailing Address - Phone:907-235-5252
Mailing Address - Fax:
Practice Address - Street 1:433 GRUBSTAKE AVE.
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603
Practice Address - Country:US
Practice Address - Phone:907-235-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK28444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist