Provider Demographics
NPI:1518578442
Name:SONNTAG, KIERSTYN (PTA)
Entity Type:Individual
Prefix:
First Name:KIERSTYN
Middle Name:
Last Name:SONNTAG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KIERSTYN
Other - Middle Name:PAIGE
Other - Last Name:LATCHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6927 OLD SEWARD HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2283
Mailing Address - Country:US
Mailing Address - Phone:907-345-0050
Mailing Address - Fax:907-344-5103
Practice Address - Street 1:6927 OLD SEWARD HWY STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-2283
Practice Address - Country:US
Practice Address - Phone:907-345-0050
Practice Address - Fax:907-344-5103
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK181591225200000X
AR4570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant