Provider Demographics
NPI:1538818737
Name:SIDNER, BRITTNEY ROSE
Entity type:Individual
Prefix:
First Name:BRITTNEY ROSE
Middle Name:
Last Name:SIDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 E ROOSEVELT BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3006
Mailing Address - Country:US
Mailing Address - Phone:267-469-4793
Mailing Address - Fax:
Practice Address - Street 1:4327 E ROOSEVELT BLVD FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3006
Practice Address - Country:US
Practice Address - Phone:267-469-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG011194225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist