Provider Demographics
NPI:1114681798
Name:SOFIA, AMBER MERRYN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MERRYN
Last Name:SOFIA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:MERRYN
Other - Middle Name:
Other - Last Name:SOFIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:126 SW RACCOON WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WHITE
Mailing Address - State:FL
Mailing Address - Zip Code:32038-2454
Mailing Address - Country:US
Mailing Address - Phone:352-870-1087
Mailing Address - Fax:
Practice Address - Street 1:18575 HIGH SPRINGS MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-0003
Practice Address - Country:US
Practice Address - Phone:352-870-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA67014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist