Provider Demographics
NPI:1134357403
Name:CALDERON, SONIA LINDA (LMT)
Entity type:Individual
Prefix:MISS
First Name:SONIA
Middle Name:LINDA
Last Name:CALDERON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 HEATHERS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-2965
Mailing Address - Country:US
Mailing Address - Phone:210-454-8508
Mailing Address - Fax:
Practice Address - Street 1:7015 HEATHERS WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-2965
Practice Address - Country:US
Practice Address - Phone:210-454-8508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT108353225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist