Provider Demographics
NPI:1821077223
Name:PRAEGER, SYDNEY LYN (RPT)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:LYN
Last Name:PRAEGER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2182
Mailing Address - Street 2:180 W 1ST ST #101
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-2182
Mailing Address - Country:US
Mailing Address - Phone:208-725-5185
Mailing Address - Fax:208-725-5192
Practice Address - Street 1:180 W 1ST ST
Practice Address - Street 2:#101
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-725-5185
Practice Address - Fax:208-725-5192
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T4850OtherBLUE CROSS OF ID
000010024770OtherBLUE SHIELD OF ID
T4850OtherBLUE CROSS OF ID