Provider Demographics
NPI:1225592504
Name:SOFIA, JOHN A (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:SOFIA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ROMAN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1111
Mailing Address - Country:US
Mailing Address - Phone:845-764-5572
Mailing Address - Fax:
Practice Address - Street 1:167 ROUTE 304 STE 108
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2050
Practice Address - Country:US
Practice Address - Phone:877-517-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11438225200000X
NY011438225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant