Healthcare Provider Details

I. General information

NPI: 1699683474
Provider Name (Legal Business Name): SYDNEY NICOLE HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 THOMPSON ST
JERSEY SHORE PA
17740-1729
US

IV. Provider business mailing address

1482 RAILROAD AVE
JULIAN PA
16844-9742
US

V. Phone/Fax

Practice location:
  • Phone: 570-398-4747
  • Fax:
Mailing address:
  • Phone: 570-367-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE1005580
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: