Provider Demographics
NPI:1396524369
Name:GUSTAF, SYDNEY LAYNE (DPT)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LAYNE
Last Name:GUSTAF
Suffix:
Gender:F
Credentials:DPT
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 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-491-1390
Mailing Address - Fax:812-492-6390
Practice Address - Street 1:1119 JOHN DEERE CIR STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-7347
Practice Address - Country:US
Practice Address - Phone:605-556-0175
Practice Address - Fax:605-556-0175
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist