Provider Demographics
NPI:1104924125
Name:BAUTISTA, SONYA M (PT, MSPT, CERT DN)
Entity type:Individual
Prefix:MS
First Name:SONYA
Middle Name:M
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:PT, MSPT, CERT DN
Other - Prefix:MS
Other - First Name:SONYA
Other - Middle Name:M
Other - Last Name:FALSNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MSPT
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:2040 JOHN ROLFE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-8111
Practice Address - Country:US
Practice Address - Phone:804-754-0916
Practice Address - Fax:804-754-0919
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050050052251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05954OtherGROUP MEDICARE PTAN