Provider Demographics
NPI:1760780555
Name:NAGLE, SONJA B (MSPT)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:B
Last Name:NAGLE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1274
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-1274
Mailing Address - Country:US
Mailing Address - Phone:386-225-5686
Mailing Address - Fax:
Practice Address - Street 1:535 LAURENS RD
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-2209
Practice Address - Country:US
Practice Address - Phone:864-476-6600
Practice Address - Fax:864-476-3514
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2906225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic