Healthcare Provider Details

I. General information

NPI: 1023737582
Provider Name (Legal Business Name): SYDNEY LADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S MAPLE AVE STE 3500
OAK PARK IL
60304-2801
US

IV. Provider business mailing address

610 S MAPLE AVE STE 3500
OAK PARK IL
60304-2801
US

V. Phone/Fax

Practice location:
  • Phone: 708-934-7062
  • Fax: 708-934-7065
Mailing address:
  • Phone: 708-934-7062
  • Fax: 708-934-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070029808
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1370245
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05014702A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: