Provider Demographics
NPI:1811880990
Name:SIDELL, MICAIAH JOY (PT)
Entity type:Individual
Prefix:
First Name:MICAIAH
Middle Name:JOY
Last Name:SIDELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5425 JONESTOWN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-4086
Mailing Address - Country:US
Mailing Address - Phone:717-210-5676
Mailing Address - Fax:717-216-8096
Practice Address - Street 1:1104 CARLISLE RD STE 170
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-6215
Practice Address - Country:US
Practice Address - Phone:717-210-5676
Practice Address - Fax:717-216-8096
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATPT023953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist