Provider Demographics
NPI: | 1639308166 |
---|---|
Name: | MASRI, SOPHIA (PT, DPM, MBA) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SOPHIA |
Middle Name: | |
Last Name: | MASRI |
Suffix: | |
Gender: | F |
Credentials: | PT, DPM, MBA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2900 SW 79TH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33155-2507 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 786-348-1751 |
Mailing Address - Fax: | 786-901-8330 |
Practice Address - Street 1: | 50 BARRACUDA LN |
Practice Address - Street 2: | |
Practice Address - City: | KEY LARGO |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33037-3733 |
Practice Address - Country: | US |
Practice Address - Phone: | 789-348-1751 |
Practice Address - Fax: | 786-901-8330 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2009-07-06 |
Last Update Date: | 2022-05-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 006454 | 213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X |
FL | 19364 | 225100000X, 2251G0304X, 2251N0400X, 2251S0007X, 2251X0800X |
NY | 023385 | 225100000X |
FL | PO3538 | 213E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | |
No | 213EP1101X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
No | 213ER0200X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Radiology |
No | 213ES0000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No | 213ES0131X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |