Provider Demographics
NPI:1679500110
Name:SONNENFELD, GREGORY BRUCE (ATC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:BRUCE
Last Name:SONNENFELD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ASSOCIATES BLVD
Mailing Address - Street 2:OUTPATIENT REHAB
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-1943
Mailing Address - Country:US
Mailing Address - Phone:865-980-7140
Mailing Address - Fax:
Practice Address - Street 1:220 ASSOCIATES BLVD
Practice Address - Street 2:OUTPATIENT REHAB
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-1943
Practice Address - Country:US
Practice Address - Phone:865-980-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer