Provider Demographics
NPI:1528570454
Name:SUN PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:SUN PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:MAINES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:512-429-2975
Mailing Address - Street 1:520 KODIAK TRL
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4108
Mailing Address - Country:US
Mailing Address - Phone:512-429-2975
Mailing Address - Fax:
Practice Address - Street 1:2324 E CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4604
Practice Address - Country:US
Practice Address - Phone:512-522-6447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1244873261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy