Basic Information
| Provider Information | |||||||||
| NPI: | 1760780555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAGLE | ||||||||
| FirstName: | SONJA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1274 | ||||||||
| Address2: | |||||||||
| City: | ROEBUCK | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293761274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862255686 | ||||||||
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| Practice Location | |||||||||
| Address1: | 535 LAURENS RD | ||||||||
| Address2: | |||||||||
| City: | WOODRUFF | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293882209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644766600 | ||||||||
| FaxNumber: | 8644763514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2011 | ||||||||
| LastUpdateDate: | 04/07/2015 | ||||||||
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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 | 225100000X | 2906 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251S0007X | 2906 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | 2251X0800X | 2906 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.