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NPI Code Detail

MEDICARE: MS. SONYA KAY MIKESKA ATC,LAT

MEDICARE: MS. SONYA KAY MIKESKA ATC,LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer1604TX

General Provider Information

NPI Number : 1194937953
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SONYA KAY MIKESKA ATC,LAT
Provider Business Mailing Address
First Line : 5125 BELAIRE DR
Second Line :
City : MIDLAND
State : TX
Zip : 79703-5355
Country : US
Telephone Number : 432-352-4381
Fax Number :
Provider Business Practice Location Address
First Line : 3600 N GARFIELD ST
Second Line :
City : MIDLAND
State : TX
Zip : 79705-6329
Country : US
Telephone Number : 432-685-4715
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2007
Last Update Date : 07/08/2007

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