Provider Demographics
NPI:1053966325
Name:WARD, SYLVETTA M (LMT)
Entity type:Individual
Prefix:
First Name:SYLVETTA
Middle Name:M
Last Name:WARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8223 FRONTIER RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7106
Mailing Address - Country:US
Mailing Address - Phone:501-551-5918
Mailing Address - Fax:
Practice Address - Street 1:301 BROOKSWOOD RD STE 11
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-4205
Practice Address - Country:US
Practice Address - Phone:501-551-5918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3267225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3267OtherMASSAGE THERAPIST LICENSE
AR155759OtherMASSAGE THERAPIST LICENSE