Provider Demographics
NPI:1720776842
Name:STIKELEATHER, SONDRA JILL (PT)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:JILL
Last Name:STIKELEATHER
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 1:610 SABLE CHASE
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1182
Mailing Address - Country:US
Mailing Address - Phone:317-752-8743
Mailing Address - Fax:
Practice Address - Street 1:610 SABLE CHASE
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1182
Practice Address - Country:US
Practice Address - Phone:317-752-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002166A2251E1200X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2063OtherNORTH CAROLINA BOARD OF PHYSICAL THERAPY EXAMINERS