Healthcare Provider Details

I. General information

NPI: 1467386896
Provider Name (Legal Business Name): SYDNEY LORAINE PRATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S 35TH ST
WEST DES MOINES IA
50265-2053
US

IV. Provider business mailing address

513 53RD PL
WEST DES MOINES IA
50266-7254
US

V. Phone/Fax

Practice location:
  • Phone: 515-633-4500
  • Fax:
Mailing address:
  • Phone: 712-577-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number139502
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: