Provider Demographics
NPI:1609060805
Name:SOPCAK, CAREY JO (PTA)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:JO
Last Name:SOPCAK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5107 ASHBAUGH RD
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-9402
Mailing Address - Country:US
Mailing Address - Phone:724-733-8898
Mailing Address - Fax:
Practice Address - Street 1:100 LITTLE DR
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3345
Practice Address - Country:US
Practice Address - Phone:724-339-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000324L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant