Individual
MRS. KELLY E. SIDLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA22900
Contact information
Practice address
1325 GRASSLANDS BLVD, LAKELAND, FL 33803-5405
(863) 413-0908
Mailing address
1325 GRASSLANDS BLVD, LAKELAND, FL 33803-5405
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
22900
FL
225200000X
Physical Therapy Assistant
PTA002232
GA
Other
Enumeration date
09/09/2011
Last updated
12/03/2021
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