Provider Demographics
NPI:1033453550
Name:SHELDON SONNENBERG
Entity Type:Organization
Organization Name:SHELDON SONNENBERG
Other - Org Name:1UP SPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:310-880-5513
Mailing Address - Street 1:4700 N CAPITAL OF TEXAS HWY APT 712
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1130
Mailing Address - Country:US
Mailing Address - Phone:310-880-5513
Mailing Address - Fax:
Practice Address - Street 1:2000 WINDY TER BLDG 10
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4287
Practice Address - Country:US
Practice Address - Phone:310-880-5513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty