Provider Demographics
NPI:1114963998
Name:YI, SOPHEAP (DPT)
Entity Type:Individual
Prefix:MR
First Name:SOPHEAP
Middle Name:
Last Name:YI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:'MATT'
Other - Middle Name:
Other - Last Name:YI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:520 HEDGE ROW LN
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-8651
Mailing Address - Country:US
Mailing Address - Phone:717-926-6677
Mailing Address - Fax:717-838-4581
Practice Address - Street 1:520 HEDGE ROW LN
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-8651
Practice Address - Country:US
Practice Address - Phone:717-926-6677
Practice Address - Fax:717-838-4581
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist