Provider Demographics
NPI:1275687956
Name:SOPP, JILLIAN (LMT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:SOPP
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 1:313 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:PA
Mailing Address - Zip Code:18517-1705
Mailing Address - Country:US
Mailing Address - Phone:570-562-7655
Mailing Address - Fax:
Practice Address - Street 1:NE REHABILITATION ASSOCIATES, PC 5 MORGAN HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508
Practice Address - Country:US
Practice Address - Phone:570-344-3788
Practice Address - Fax:570-614-0212
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG000559225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist