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General NPI Number Information
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NPI Number | 1871084996
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Entity Type | Individual
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Provider Name | SYDNEY POULIOPOULOS MAT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 175 FOREST ST
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City | WALTHAM
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State | MA
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Zip | 02452-4713
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Country | US
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Telephone | 781-891-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 17 BYRNE AVE
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City | WESTFORD
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State | MA
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Zip | 01886-1563
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Country | US
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Telephone | 978-846-5788
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATL3653
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License Number State | MA
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