Healthcare Provider Details

I. General information

NPI: 1386584175
Provider Name (Legal Business Name): SYDNEY ALLEN ATC,LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAGNOLIA AVE
DURANT OK
74701
US

IV. Provider business mailing address

151 S BUDDY HAYES BLVD APT 5017
ANNA TX
75409-6231
US

V. Phone/Fax

Practice location:
  • Phone: 512-436-1553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1438
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: