Provider Demographics
NPI:1255360814
Name:FJELD, SYLVIA IRENE (PT)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:IRENE
Last Name:FJELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 MAPLE RUN LN
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-4044
Mailing Address - Country:US
Mailing Address - Phone:802-253-4557
Mailing Address - Fax:
Practice Address - Street 1:67 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-3235
Practice Address - Country:US
Practice Address - Phone:802-878-9513
Practice Address - Fax:802-878-9962
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT40-2584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008289Medicaid
VTVN3250Medicare ID - Type Unspecified