MEDICARE: STEPHANIE SIDONI DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	027910	NY

General Provider Information

NPI Number	:	1609830256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SIDONI DPT

Provider Business Mailing Address
First Line	:	231 WALTON ST
Second Line	:	SUITE 231
City	:	SYRACUSE
State	:	NY
Zip	:	13202-1230
Country	:	US
Telephone Number	:	315-478-0380
Fax Number	:	315-478-0388

Provider Business Practice Location Address
First Line	:	4994 W SENECA TPKE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-2279
Country	:	US
Telephone Number	:	315-469-5990
Fax Number	:	315-469-5650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	05/05/2008

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Directions to “ STEPHANIE SIDONI DPT” Practice Location

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