Provider Demographics
NPI:1598936114
Name:STOLLAK, SONDRA G (RPT)
Entity Type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:G
Last Name:STOLLAK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 W COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8226
Mailing Address - Country:US
Mailing Address - Phone:561-632-1145
Mailing Address - Fax:561-630-2011
Practice Address - Street 1:3144 W COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8226
Practice Address - Country:US
Practice Address - Phone:561-632-1145
Practice Address - Fax:561-630-2011
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist