Provider Demographics
NPI:1891900213
Name:SYLVIA, BRENT (PT)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SYLVIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W DEMING ST EXT
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226-1115
Mailing Address - Country:US
Mailing Address - Phone:413-684-1784
Mailing Address - Fax:
Practice Address - Street 1:1450 EAST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5319
Practice Address - Country:US
Practice Address - Phone:413-442-0610
Practice Address - Fax:413-442-0689
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist