Provider Demographics
NPI:1396237384
Name:GAYTAN, SYDNEY DEANN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:DEANN
Last Name:GAYTAN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5733 CURTIS CLARK DR APT 1434
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4594
Mailing Address - Country:US
Mailing Address - Phone:210-391-0293
Mailing Address - Fax:
Practice Address - Street 1:5733 CURTIS CLARK DR APT 1434
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4594
Practice Address - Country:US
Practice Address - Phone:210-391-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT75032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer