Provider Demographics
NPI:1447732052
Name:SIDES, HARLY
Entity type:Individual
Prefix:
First Name:HARLY
Middle Name:
Last Name:SIDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HARLY
Other - Middle Name:
Other - Last Name:SIDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:630 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1639
Mailing Address - Country:US
Mailing Address - Phone:570-647-7762
Mailing Address - Fax:215-798-7969
Practice Address - Street 1:HARLY SIDES
Practice Address - Street 2:630 MEADOW LANE
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438
Practice Address - Country:US
Practice Address - Phone:570-647-7762
Practice Address - Fax:215-798-7969
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist