Provider Demographics
NPI:1396110417
Name:SIDES, BRANDY NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:NICOLE
Last Name:SIDES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:NICOLE
Other - Last Name:BARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4101 SOUTHPOINT DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0996
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4101 SOUTHPOINT DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0996
Practice Address - Country:US
Practice Address - Phone:904-296-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 31018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist