Basic Information
Provider Information
NPI: 1578952842
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARRISON
FirstName: SONYA
MiddleName: LOUISE
NamePrefix: DR.
NameSuffix:  
Credential: D.P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 40000
Address2:  
City: VAIL
State: CO
PostalCode: 816587520
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 181 W MEADOW DR
Address2:  
City: VAIL
State: CO
PostalCode: 816575242
CountryCode: US
TelephoneNumber: 9704761225
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/09/2015
LastUpdateDate: 06/24/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/24/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X3116527TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
2251X0800X14376COY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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