Healthcare Provider Details

I. General information

NPI: 1801366513
Provider Name (Legal Business Name): SYDNEI JOY ANDERSON PTA, ATP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date: 03/29/2023
Reactivation Date: 05/16/2023

III. Provider practice location address

1221 PROFIT DR
DALLAS TX
75247-3919
US

IV. Provider business mailing address

1221 PROFIT DR
DALLAS TX
75247-3919
US

V. Phone/Fax

Practice location:
  • Phone: 214-658-9097
  • Fax:
Mailing address:
  • Phone: 214-658-9097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2089136
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: