Provider Demographics
NPI:1063471522
Name:ANDERSON, SONYA D (RPT)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5622 SHERIDAN LAKE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8881
Mailing Address - Country:US
Mailing Address - Phone:605-399-9565
Mailing Address - Fax:605-399-9584
Practice Address - Street 1:4141 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6021
Practice Address - Country:US
Practice Address - Phone:605-399-9565
Practice Address - Fax:605-399-9584
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD39822OtherSANFORD HEALTH
SD0881OtherDAKOTACARE
SD4998871OtherWELLMARK
SD5831720Medicaid
SDS101430Medicare PIN
SD0881OtherDAKOTACARE