Provider Demographics
NPI:1538205406
Name:SYLVESTER, MAUREEN J (P T)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:J
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SWEETBRIAR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523
Mailing Address - Country:US
Mailing Address - Phone:309-274-6314
Mailing Address - Fax:309-274-4100
Practice Address - Street 1:525 SWEETBRIAR
Practice Address - Street 2:SUITE C
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523
Practice Address - Country:US
Practice Address - Phone:309-274-6314
Practice Address - Fax:309-274-4100
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist