Provider Demographics
NPI:1073005344
Name:BRETL, SOFIIA (LMT)
Entity Type:Individual
Prefix:
First Name:SOFIIA
Middle Name:
Last Name:BRETL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 W 27TH ST STE 404
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6258
Mailing Address - Country:US
Mailing Address - Phone:917-562-2285
Mailing Address - Fax:
Practice Address - Street 1:153 W 27TH ST STE 404
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6258
Practice Address - Country:US
Practice Address - Phone:917-562-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist