Provider Demographics
NPI:1679829618
Name:SONDAG, MARY HORTON (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HORTON
Last Name:SONDAG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25892 EL SEGUNDO ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-6201
Mailing Address - Country:US
Mailing Address - Phone:925-818-6127
Mailing Address - Fax:
Practice Address - Street 1:25892 EL SEGUNDO ST
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-6201
Practice Address - Country:US
Practice Address - Phone:925-818-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist