Provider Demographics
NPI:1477841260
Name:STAN, SYDNEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:STAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SETON CENTER PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4107
Mailing Address - Country:US
Mailing Address - Phone:512-439-1000
Mailing Address - Fax:512-439-1081
Practice Address - Street 1:700 E WHITESTONE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6032
Practice Address - Country:US
Practice Address - Phone:512-260-9600
Practice Address - Fax:512-260-9601
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1254107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist