Provider Demographics
NPI:1720209455
Name:HARDIN, SYDNEY LYNNE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LYNNE
Last Name:HARDIN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2698 BLUE STEM DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-8215
Mailing Address - Country:US
Mailing Address - Phone:219-713-2407
Mailing Address - Fax:
Practice Address - Street 1:2698 BLUE STEM DR
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-8215
Practice Address - Country:US
Practice Address - Phone:219-713-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010016742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer