Provider Demographics
NPI:1487688115
Name:ANDERSON, SIDNEY K (PT)
Entity Type:Individual
Prefix:MS
First Name:SIDNEY
Middle Name:K
Last Name:ANDERSON
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 1:3035 SILVERN LN
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-306-1103
Mailing Address - Fax:360-715-1895
Practice Address - Street 1:2130 GRANT ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-306-1103
Practice Address - Fax:360-715-1895
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA105059OtherL&I OF WA
WA7078793Medicaid
WA105059OtherL&I OF WA
S28844Medicare UPIN