Provider Demographics
NPI:1023230356
Name:WORTHY- OKOLO, SONYA R (PT)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:R
Last Name:WORTHY- OKOLO
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 1:5803 SORA LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-3517
Mailing Address - Country:US
Mailing Address - Phone:301-345-9678
Mailing Address - Fax:
Practice Address - Street 1:12164 CENTRAL AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1944
Practice Address - Country:US
Practice Address - Phone:301-333-2703
Practice Address - Fax:301-333-2705
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist