Provider Demographics
NPI:1376968594
Name:SMITH, SONYA LAUREN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:LAUREN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:LAUREN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1046 WARTERS CV
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1398
Mailing Address - Country:US
Mailing Address - Phone:315-945-0814
Mailing Address - Fax:
Practice Address - Street 1:100 RAWSON RD STE 220
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1100
Practice Address - Country:US
Practice Address - Phone:315-945-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032950-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist