Provider Demographics
NPI:1386276293
Name:GREENE, SYDNEY DESIRA (DPT)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:DESIRA
Last Name:GREENE
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 1:305 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-8085
Mailing Address - Country:US
Mailing Address - Phone:870-405-2144
Mailing Address - Fax:
Practice Address - Street 1:300 GOOD SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-5813
Practice Address - Country:US
Practice Address - Phone:870-425-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist