MEDICARE: LAUREN R. SYLVAIN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT022921	PA
2	225100000X	Physical Therapist	2305210742	VA

General Provider Information

NPI Number	:	1538603527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN R. SYLVAIN PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 69030
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-9030
Country	:	US
Telephone Number	:	757-873-2302
Fax Number	:	757-873-2306

Provider Business Practice Location Address
First Line	:	2033 COLONIAL AVE SW STE 138
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-3210
Country	:	US
Telephone Number	:	540-466-3981
Fax Number	:	540-739-7476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2016
Last Update Date	:	05/08/2018

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