Provider Demographics
NPI:1912626565
Name:SIDHU, HANNA (DPT, PT)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:SIDHU
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SYCAMORE AVE APT 633
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6723
Mailing Address - Country:US
Mailing Address - Phone:404-567-3513
Mailing Address - Fax:
Practice Address - Street 1:2230 ASHLEY CROSSING DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5700
Practice Address - Country:US
Practice Address - Phone:843-766-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist