Provider Demographics
NPI:1073096731
Name:ENSZ, SONIA CATHERINE (PTA, CLT)
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:CATHERINE
Last Name:ENSZ
Suffix:
Gender:F
Credentials:PTA, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20326 ANTLER FARMS DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-0633
Mailing Address - Country:US
Mailing Address - Phone:405-938-5882
Mailing Address - Fax:
Practice Address - Street 1:612 W 18TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3631
Practice Address - Country:US
Practice Address - Phone:405-330-3994
Practice Address - Fax:405-330-4231
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1615225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant