Provider Demographics
NPI:1689300311
Name:ALLEN, SYDNEY EVELYN (DPT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:EVELYN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020-2503
Mailing Address - Country:US
Mailing Address - Phone:660-463-2588
Mailing Address - Fax:
Practice Address - Street 1:607 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020-2503
Practice Address - Country:US
Practice Address - Phone:660-463-2588
Practice Address - Fax:660-463-2589
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-8113225100000X
MO2022029304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist