Provider Demographics
NPI:1336254796
Name:RISSER, SYDNEY LYNN (PT)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:LYNN
Last Name:RISSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2318 16TH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2643
Mailing Address - Country:US
Mailing Address - Phone:310-581-6848
Mailing Address - Fax:310-581-6846
Practice Address - Street 1:2664 29TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2916
Practice Address - Country:US
Practice Address - Phone:310-392-8259
Practice Address - Fax:310-392-8274
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT168622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic