Provider Demographics
NPI:1891279071
Name:SIDHOM, NOREEN (PT DPT)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:
Last Name:SIDHOM
Suffix:
Gender:F
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 1:1122 AUGUSTUS DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8630
Mailing Address - Country:US
Mailing Address - Phone:732-713-7403
Mailing Address - Fax:
Practice Address - Street 1:2868 S ALAFAYA TRL STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7974
Practice Address - Country:US
Practice Address - Phone:407-214-0100
Practice Address - Fax:908-436-1084
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA1823000225100000X
FLPT36276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist