Healthcare Provider Details

I. General information

NPI: 1598970097
Provider Name (Legal Business Name): STEVEN SYCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 FALCONS VIEW CT.
WALHALLA SC
29691
US

IV. Provider business mailing address

112 FALCONS VEIW CT
WALHALLA SC
29691
US

V. Phone/Fax

Practice location:
  • Phone: 864-718-0367
  • Fax:
Mailing address:
  • Phone: 864-718-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number1390
License Number StateSC

VIII. Authorized Official

Name: MR. STEVEN ANDREW SYCK
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential: PHYSICAL THERAPIST A
Phone: 864-718-0367