Provider Demographics
NPI:1326293846
Name:MASCARELLA, SOPHIA S (LMT)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:S
Last Name:MASCARELLA
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 1:393 PALM COAST PKWY SW
Mailing Address - Street 2:UNIT 3
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4773
Mailing Address - Country:US
Mailing Address - Phone:386-864-2686
Mailing Address - Fax:
Practice Address - Street 1:393 PALM COAST PKWY SW
Practice Address - Street 2:UNIT 3
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4773
Practice Address - Country:US
Practice Address - Phone:386-864-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA11536225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist