Healthcare Provider Details

I. General information

NPI: 1992854236
Provider Name (Legal Business Name): THIERRY J SYLVA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 VETERANS PARK DR UNIT 101
NAPLES FL
34109-0446
US

IV. Provider business mailing address

27119 MATHESON AVE UNIT 208
BONITA SPRINGS FL
34135-3914
US

V. Phone/Fax

Practice location:
  • Phone: 239-593-0918
  • Fax:
Mailing address:
  • Phone: 786-210-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: