Provider Demographics
NPI:1427386093
Name:POWERS, MARSOPHIA
Entity Type:Individual
Prefix:MS
First Name:MARSOPHIA
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO DRAWER PH
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-0277
Mailing Address - Country:US
Mailing Address - Phone:928-674-7223
Mailing Address - Fax:928-674-7559
Practice Address - Street 1:HWY 191 & HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503-0277
Practice Address - Country:US
Practice Address - Phone:928-674-7223
Practice Address - Fax:928-674-7559
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004190328Medicaid
CT004190328Medicaid