Provider Demographics
NPI:1649745894
Name:MAYNARD, SONIA A (PT)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:A
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:SANCHEZ PAREDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6450 ARK RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3358
Mailing Address - Country:US
Mailing Address - Phone:316-925-1274
Mailing Address - Fax:
Practice Address - Street 1:6450 ARK RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-3358
Practice Address - Country:US
Practice Address - Phone:316-925-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK133714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist