Provider Demographics
NPI:1780158055
Name:SYDERS, FAITH MICHELLE (PTA)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:MICHELLE
Last Name:SYDERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:MICHELLE
Other - Last Name:RAIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-4939
Mailing Address - Country:US
Mailing Address - Phone:253-833-7711
Mailing Address - Fax:
Practice Address - Street 1:502 29TH ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7532
Practice Address - Country:US
Practice Address - Phone:253-939-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160047566225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant