Provider Demographics
NPI:1144413543
Name:SOPHABMYXAY, NIPHAPHONE (PT)
Entity Type:Individual
Prefix:MS
First Name:NIPHAPHONE
Middle Name:
Last Name:SOPHABMYXAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 RED ROSE DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-2328
Mailing Address - Country:US
Mailing Address - Phone:267-251-1784
Mailing Address - Fax:
Practice Address - Street 1:350 MANOR AVE
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2943
Practice Address - Country:US
Practice Address - Phone:215-757-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist