Provider Demographics
NPI:1730396797
Name:SIDES, AMY KRISTEN (DPT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KRISTEN
Last Name:SIDES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11620 WHOOPING CRANE CIR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4306
Mailing Address - Country:US
Mailing Address - Phone:303-840-8924
Mailing Address - Fax:
Practice Address - Street 1:1025 S PERRY ST STE 101
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-3365
Practice Address - Country:US
Practice Address - Phone:303-688-5885
Practice Address - Fax:303-688-5903
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805137OtherMEDICARE GROUP
CO811016Medicare PIN