Provider Demographics
NPI:1912047853
Name:DICK, SONYA C (MSPT, CWS)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:C
Last Name:DICK
Suffix:
Gender:F
Credentials:MSPT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1317
Mailing Address - Country:US
Mailing Address - Phone:312-213-1995
Mailing Address - Fax:708-531-7936
Practice Address - Street 1:1219 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-4046
Practice Address - Country:US
Practice Address - Phone:708-216-5300
Practice Address - Fax:708-531-7936
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist