Provider Demographics
NPI:1699081638
Name:SOCONG, SHERYL BARADSAR (PT)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:BARADSAR
Last Name:SOCONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:A
Other - Last Name:BARADSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 S PECOS ST
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-4159
Mailing Address - Country:US
Mailing Address - Phone:325-625-2135
Mailing Address - Fax:325-625-4329
Practice Address - Street 1:310 S PECOS ST
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-4159
Practice Address - Country:US
Practice Address - Phone:325-625-2135
Practice Address - Fax:325-625-4329
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1195490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist