Provider Demographics
NPI:1184674368
Name:IRONSIDE, AUDREY (PT)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:
Last Name:IRONSIDE
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 1:1782 TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2435
Mailing Address - Country:US
Mailing Address - Phone:561-775-6332
Mailing Address - Fax:
Practice Address - Street 1:2501 BURNS RD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5207
Practice Address - Country:US
Practice Address - Phone:561-627-4427
Practice Address - Fax:561-627-2798
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist