Provider Demographics
NPI:1972273308
Name:FIELDS, SYDNEY RAE
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:RAE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W BRIARBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CARL JUNCTION
Mailing Address - State:MO
Mailing Address - Zip Code:64834-8413
Mailing Address - Country:US
Mailing Address - Phone:620-704-3237
Mailing Address - Fax:
Practice Address - Street 1:406 W BRIARBROOK LN
Practice Address - Street 2:
Practice Address - City:CARL JUNCTION
Practice Address - State:MO
Practice Address - Zip Code:64834-8413
Practice Address - Country:US
Practice Address - Phone:620-704-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03863225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant