Active NPI
Keely Jauch Sidick, PT
- Physical Therapist
- Glenshaw, PA
National Provider Identifier
1487771333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT007759L
- Practice address
- 330 Wetzel Rd
Glenshaw, PA 15116-2239 - Phone
- (412) 486-4579
- NPI assigned
- Mar 24, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT007759L | PA | Primary |
Addresses
Primary practice location
330 Wetzel Rd
Glenshaw, PA 15116-2239
Mailing address
330 Wetzel Rd
Glenshaw, PA 15116-2239
Phone (412) 486-4579
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01791008 | Other | PA | MA ID MPI PROVIDER PROMIS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT007759L | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487771333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 WETZEL RD",
"city": "GLENSHAW",
"state": "PA",
"postal_code": "151162239",
"telephone_number": "412-486-4579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 WETZEL RD",
"city": "GLENSHAW",
"state": "PA",
"postal_code": "151162239",
"telephone_number": "412-486-4579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDICK",
"first_name": "KEELY",
"middle_name": "JAUCH",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT007759L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MA ID MPI PROVIDER PROMIS",
"identifier": "01791008",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glenshaw, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.