Provider Demographics
NPI:1285528844
Name:NOWLEN, SYDNIE NICOLE (LPTA)
Entity type:Individual
Prefix:
First Name:SYDNIE
Middle Name:NICOLE
Last Name:NOWLEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-0075
Mailing Address - Country:US
Mailing Address - Phone:769-216-3288
Mailing Address - Fax:601-510-9012
Practice Address - Street 1:5140 GALAXIE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4335
Practice Address - Country:US
Practice Address - Phone:769-216-3288
Practice Address - Fax:601-510-9012
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA7601225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant