Provider Demographics
NPI:1285771766
Name:SYPHERD, JENNIFER DIANE (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DIANE
Last Name:SYPHERD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5541 LIBRARY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-3611
Mailing Address - Country:US
Mailing Address - Phone:412-835-6290
Mailing Address - Fax:412-835-6290
Practice Address - Street 1:1417 WIGHTMAN ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217
Practice Address - Country:US
Practice Address - Phone:412-421-0310
Practice Address - Fax:412-421-0312
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015253174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist