Provider Demographics
NPI:1346581196
Name:PEZZELLE, SONJA (MA71806)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:PEZZELLE
Suffix:
Gender:F
Credentials:MA71806
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 LANTANA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6915
Mailing Address - Country:US
Mailing Address - Phone:561-901-1731
Mailing Address - Fax:
Practice Address - Street 1:4550 LANTANA RD
Practice Address - Street 2:SUITE A4
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6997
Practice Address - Country:US
Practice Address - Phone:561-901-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA71806225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist