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General NPI Number Information
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NPI Number | 1417167875
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Entity Type | Individual
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Provider Name | SYLVIA R CONSTABLE LMT
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 918 OLD LIVERPOOL RD
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City | LIVERPOOL
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State | NY
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Zip | 13088-5513
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Country | US
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Telephone | 315-243-9124
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Fax | 315-451-0200
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Provider Business Mailing Address
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Address Line | 3223 ISLE OF PNES
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-2010
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Country | US
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Telephone | 315-638-7837
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 015499
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License Number State | NY
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