Provider Demographics
NPI:1891917530
Name:HOLMES, SONDRA LOUISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:LOUISE
Last Name:HOLMES
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:RR 4 BOX 4168
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-9741
Mailing Address - Country:US
Mailing Address - Phone:570-222-4629
Mailing Address - Fax:570-488-7154
Practice Address - Street 1:476 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472-9304
Practice Address - Country:US
Practice Address - Phone:570-488-5100
Practice Address - Fax:570-488-7154
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005892-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW2299030OtherAETNA
PA808619OtherFIRST PRIORITY HEALTH