Provider Demographics
NPI:1669530903
Name:WISDOM, SONYA LEE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:LEE
Last Name:WISDOM
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MS
Other - First Name:SONYA
Other - Middle Name:LEE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:3160 EASTOVER ROAD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37184
Mailing Address - Country:US
Mailing Address - Phone:615-449-2266
Mailing Address - Fax:
Practice Address - Street 1:420 N UNIVERSITY
Practice Address - Street 2:NHC MURFREESBORO
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:615-893-2602
Practice Address - Fax:615-890-1224
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA1891225200000X
ALPTA762225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant