Provider Demographics
NPI:1639652951
Name:BREDEHOEFT, SYDNEY ANNE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ANNE
Last Name:BREDEHOEFT
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8682 HICKORY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLACKBURN
Mailing Address - State:MO
Mailing Address - Zip Code:65321-2004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 ABBOTT AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2895
Practice Address - Country:US
Practice Address - Phone:254-582-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TXAT75722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer