Provider Demographics
NPI:1801366513
Name:ANDERSON, SYDNEI JOY (PTA, ATP)
Entity Type:Individual
Prefix:
First Name:SYDNEI
Middle Name:JOY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PTA, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 PROFIT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-3919
Mailing Address - Country:US
Mailing Address - Phone:214-658-9097
Mailing Address - Fax:
Practice Address - Street 1:1221 PROFIT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3919
Practice Address - Country:US
Practice Address - Phone:214-658-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2023-07-31
Deactivation Date:2023-03-29
Deactivation Code:
Reactivation Date:2023-05-16
Provider Licenses
StateLicense IDTaxonomies
TX2089136225200000X
TX247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant