Provider Demographics
NPI:1871084996
Name:POULIOPOULOS, SYDNEY (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:POULIOPOULOS
Suffix:
Gender:
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BYRNE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1563
Mailing Address - Country:US
Mailing Address - Phone:978-846-5788
Mailing Address - Fax:
Practice Address - Street 1:175 FOREST ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-4713
Practice Address - Country:US
Practice Address - Phone:781-891-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAATL36532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer