Provider Demographics
NPI:1609932706
Name:SONNIER, BOBBIE JO (MS,PT)
Entity Type:Individual
Prefix:MS
First Name:BOBBIE
Middle Name:JO
Last Name:SONNIER
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:MISS
Other - First Name:BOBBIE
Other - Middle Name:JO
Other - Last Name:HUSTED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,PT
Mailing Address - Street 1:11700 HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-5218
Mailing Address - Country:US
Mailing Address - Phone:901-606-8239
Mailing Address - Fax:
Practice Address - Street 1:2606 CORPORATE AVE E
Practice Address - Street 2:SUITE 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-1708
Practice Address - Country:US
Practice Address - Phone:901-380-4404
Practice Address - Fax:901-380-1340
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT000006001225100000X
MSPT3048225100000X
FLPT 24066225100000X
GAPT009461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36572341OtherMEDICARE INDIVIDUAL PTAN