Basic Information
| Provider Information | |||||||||
| NPI: | 1528403151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUTZMAN | ||||||||
| FirstName: | SONYA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PTA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | TATUM | ||||||||
| OtherFirstName: | SONYA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 117 ARGO ST APT D | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615713257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3092673961 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13609 CALIFORNIA STREET | ||||||||
| Address2: | AUREUS MEDICAL | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028911118 | ||||||||
| FaxNumber: | 4028957812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2013 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 160.005574 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.