Provider Demographics
NPI:1245418870
Name:SONNENBERG, SHELDON (PT)
Entity Type:Individual
Prefix:MR
First Name:SHELDON
Middle Name:
Last Name:SONNENBERG
Suffix:
Gender:M
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:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:BALLINGER
Mailing Address - State:TX
Mailing Address - Zip Code:76821-0127
Mailing Address - Country:US
Mailing Address - Phone:512-850-5288
Mailing Address - Fax:214-237-1283
Practice Address - Street 1:136 GLASS ST STE 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-6930
Practice Address - Country:US
Practice Address - Phone:469-626-7254
Practice Address - Fax:214-237-1283
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1174403OtherTX LICENSE