Provider Demographics
NPI:1114184728
Name:SIEGEL, SONDRA (PT)
Entity Type:Individual
Prefix:DR
First Name:SONDRA
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 HURD POINT RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04429-4221
Mailing Address - Country:US
Mailing Address - Phone:207-843-6672
Mailing Address - Fax:866-220-5031
Practice Address - Street 1:179 HURD POINT RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:ME
Practice Address - Zip Code:04429-4221
Practice Address - Country:US
Practice Address - Phone:207-843-6672
Practice Address - Fax:866-220-5031
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1114184728OtherANTHEM OF MAINE
ME001118301Medicare PIN