Provider Demographics
NPI:1275045890
Name:SOMMARS, FAY ELAINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:FAY
Middle Name:ELAINE
Last Name:SOMMARS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 TRADING BND
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6372
Mailing Address - Country:US
Mailing Address - Phone:928-380-0227
Mailing Address - Fax:
Practice Address - Street 1:8017 MESA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1300
Practice Address - Country:US
Practice Address - Phone:512-791-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1299069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist