Provider Demographics
NPI:1427441310
Name:WENDEBORN, SOPHIA II (PTA)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:WENDEBORN
Suffix:II
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SE MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2801
Mailing Address - Country:US
Mailing Address - Phone:210-924-4475
Mailing Address - Fax:210-924-9251
Practice Address - Street 1:1111 SE MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2801
Practice Address - Country:US
Practice Address - Phone:210-924-4475
Practice Address - Fax:210-924-9251
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2027662261QP2000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy