Provider Demographics
NPI:1417150442
Name:SHORTRIDGE, SONIA (PT)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:SHORTRIDGE
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 1:7422 ASHLEY SHORES CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7618
Mailing Address - Country:US
Mailing Address - Phone:561-433-8432
Mailing Address - Fax:
Practice Address - Street 1:9291 GLADES RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3959
Practice Address - Country:US
Practice Address - Phone:561-955-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885283900Medicaid