Provider Demographics
NPI:1689953747
Name:TIEDEMAN, SONYA KAYE (PT)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:KAYE
Last Name:TIEDEMAN
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 1:2525 S NICOLLET ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3623
Mailing Address - Country:US
Mailing Address - Phone:712-276-1291
Mailing Address - Fax:
Practice Address - Street 1:3501 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3641
Practice Address - Country:US
Practice Address - Phone:402-494-4273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist