Provider Demographics
NPI:1083828354
Name:SONICKSEN, TEAH J (ATC,LAT)
Entity Type:Individual
Prefix:MISS
First Name:TEAH
Middle Name:J
Last Name:SONICKSEN
Suffix:
Gender:F
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9536 N COUNTY ROAD 500 E
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167-9247
Mailing Address - Country:US
Mailing Address - Phone:317-286-8178
Mailing Address - Fax:
Practice Address - Street 1:8244 E US HIGHWAY 36
Practice Address - Street 2:1260
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9575
Practice Address - Country:US
Practice Address - Phone:317-718-4263
Practice Address - Fax:317-272-7855
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22OtherATHLETIC TRAINER