Provider Demographics
NPI:1679186910
Name:RODRIGUEZ, SYDNEY LAUREN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LAUREN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:LAUREN
Other - Last Name:BUSSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1136 N HAZELWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2930
Mailing Address - Country:US
Mailing Address - Phone:785-734-7061
Mailing Address - Fax:
Practice Address - Street 1:2300 N TYLER RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-8766
Practice Address - Country:US
Practice Address - Phone:316-448-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist