Healthcare Provider Details

I. General information

NPI: 1215735865
Provider Name (Legal Business Name): SYDNEY HLAVACEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W ANN ARBOR TRL STE 220
PLYMOUTH MI
48170-6224
US

IV. Provider business mailing address

801 W ANN ARBOR TRL STE 220
PLYMOUTH MI
48170-6224
US

V. Phone/Fax

Practice location:
  • Phone: 866-991-0900
  • Fax:
Mailing address:
  • Phone: 866-991-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL28185
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: