MEDICARE: NOREEN SIDHOM PT 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	40QA1823000	NJ
2	225100000X	Physical Therapist	PT36276	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891279071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOREEN SIDHOM PT DPT

Provider Business Mailing Address
First Line	:	1122 AUGUSTUS DR
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-8630
Country	:	US
Telephone Number	:	732-713-7403
Fax Number	:

Provider Business Practice Location Address
First Line	:	2868 S ALAFAYA TRL STE 100
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7974
Country	:	US
Telephone Number	:	407-214-0100
Fax Number	:	908-436-1084

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

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	03/25/2024

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Directions to “ NOREEN SIDHOM PT DPT” Practice Location

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