Provider Demographics
NPI:1700213063
Name:SIKORA, IAN LAWRENCE (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:LAWRENCE
Last Name:SIKORA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1128
Mailing Address - Country:US
Mailing Address - Phone:301-699-1936
Mailing Address - Fax:
Practice Address - Street 1:660 KENILWORTH DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2313
Practice Address - Country:US
Practice Address - Phone:410-296-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist