Provider Demographics
NPI:1831464981
Name:PULL, SONJA KRISTEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:KRISTEN
Last Name:PULL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 VERDUGO WAY
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8632
Mailing Address - Country:US
Mailing Address - Phone:661-345-7197
Mailing Address - Fax:
Practice Address - Street 1:27924 SECO CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3870
Practice Address - Country:US
Practice Address - Phone:661-513-2140
Practice Address - Fax:661-513-2141
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFZ849ZMedicare PIN