Healthcare Provider Details

I. General information

NPI: 1124809496
Provider Name (Legal Business Name): HARMANDEEP SIDHU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15350 BARRANCA PKWY
IRVINE CA
92618-2215
US

IV. Provider business mailing address

12806 BEECHFIELD DR
BAKERSFIELD CA
93312-5819
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-1460
  • Fax:
Mailing address:
  • Phone: 661-345-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number304949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: