Healthcare Provider Details

I. General information

NPI: 1184105447
Provider Name (Legal Business Name): SONIA P CORTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10061 SWEETWATER PKWY
JACKSONVILLE FL
32256-3977
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 904-618-3778
  • Fax:
Mailing address:
  • Phone: 856-678-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: