Provider Demographics
NPI:1558115980
Name:PETIT, SIDRA (PT, DPT, CCS)
Entity Type:Individual
Prefix:
First Name:SIDRA
Middle Name:
Last Name:PETIT
Suffix:
Gender:F
Credentials:PT, DPT, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 LINDSTROM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-7063
Mailing Address - Country:US
Mailing Address - Phone:614-499-7643
Mailing Address - Fax:
Practice Address - Street 1:3481 LINDSTROM DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-7063
Practice Address - Country:US
Practice Address - Phone:614-499-7643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0149042251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary