Basic Information
Provider Information
NPI: 1801810544
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ULBRICH
FirstName: SONDRA
MiddleName: LYNN
NamePrefix: MS.
NameSuffix:  
Credential: MSPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7296 GARY AVE
Address2:  
City: MIAMI BEACH
State: FL
PostalCode: 331412507
CountryCode: US
TelephoneNumber: 3058680941
FaxNumber:  
Practice Location
Address1: 1611 NW 12TH AVE
Address2: JACKSON MEMORIAL HOSPITAL REHABILITATION CENTER ROOM 14
City: MIAMI
State: FL
PostalCode: 331361005
CountryCode: US
TelephoneNumber: 3055856334
FaxNumber: 3055850091
Other Information
ProviderEnumerationDate: 07/26/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT20071FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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