MEDICARE: CHRISTINE MYLOTT

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	031547	NY

General Provider Information

NPI Number	:	1750617932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MYLOTT

Provider Business Mailing Address
First Line	:	460 S MAIN ST APT 171
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-3038
Country	:	US
Telephone Number	:	518-929-5888
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 S MAIN ST APT 171
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-3038
Country	:	US
Telephone Number	:	518-929-5888
Fax Number	:

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

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	10/23/2009

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Directions to “ CHRISTINE MYLOTT ” Practice Location

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