Provider Demographics
NPI:1790779387
Name:SIDOTI, KARA L (PT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:L
Last Name:SIDOTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:L
Other - Last Name:ENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:315 S MANNING BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1707
Practice Address - Country:US
Practice Address - Phone:518-525-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0231021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY229239OtherWELLCARE
NY7420251OtherAETNA
NY10057237OtherCDPHP
NY000498957004OtherBSNENY
NY6698000OtherGHI PPO
NY710661OtherMVP
NYQ02A21OtherEMPIRE AND BLUE CHOICE
NY75145OtherGHI HMO