Provider Demographics
NPI:1053409938
Name:SYLVESTER, STEPHEN (RPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4298 ELYSIAN FIELDS AVE
Mailing Address - Street 2:STE. C.
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3848
Mailing Address - Country:US
Mailing Address - Phone:504-282-4406
Mailing Address - Fax:504-282-4407
Practice Address - Street 1:4298 ELYSIAN FIELDS AVE
Practice Address - Street 2:STE. C.
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3848
Practice Address - Country:US
Practice Address - Phone:504-282-4406
Practice Address - Fax:504-282-4407
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA48257OtherBLUE CROSS BLUE SHIELD
LA5245416OtherAETNA
LA1560308Medicaid
LA5S691Medicare ID - Type Unspecified