=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891900213
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENT SYLVIA PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1450 EAST ST SUITE 2
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-5319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-442-0610
-----------------------------------------------------
Fax | 413-442-0689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 W DEMING ST EXT
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01226-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-684-1784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 13256
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------