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NPI Code Detail

MEDICARE: MS. SONYA KAYE TIEDEMAN PT

MEDICARE: MS. SONYA KAYE TIEDEMAN PT
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
1225100000XPhysical Therapist1392NE

General Provider Information

NPI Number : 1689953747
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SONYA KAYE TIEDEMAN PT
Provider Business Mailing Address
First Line : 2525 S NICOLLET ST
Second Line :
City : SIOUX CITY
State : IA
Zip : 51106-3623
Country : US
Telephone Number : 712-276-1291
Fax Number :
Provider Business Practice Location Address
First Line : 3501 DAKOTA AVE
Second Line :
City : SOUTH SIOUX CITY
State : NE
Zip : 68776-3641
Country : US
Telephone Number : 402-494-4273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2011
Last Update Date : 08/08/2011

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