Provider Demographics
NPI:1255951885
Name:SONNIER, MITCHELL DANE JR (LMT)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:DANE
Last Name:SONNIER
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8205
Mailing Address - Country:US
Mailing Address - Phone:832-264-3549
Mailing Address - Fax:
Practice Address - Street 1:5005 W 34TH ST STE 200B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6676
Practice Address - Country:US
Practice Address - Phone:832-264-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101705225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist