Provider Demographics
NPI:1134249394
Name:SYNROD, MARIE (BS,LMT,NCTMB)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:SYNROD
Suffix:
Gender:F
Credentials:BS,LMT,NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5336 BROAADWAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086
Mailing Address - Country:US
Mailing Address - Phone:716-681-1099
Mailing Address - Fax:716-681-6687
Practice Address - Street 1:5336 BROAADWAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086
Practice Address - Country:US
Practice Address - Phone:716-681-1099
Practice Address - Fax:716-681-6687
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008872-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist