Provider Demographics
NPI:1699412684
Name:DEEN, SOPHIA HANNAH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:HANNAH
Last Name:DEEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 BAY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4560
Mailing Address - Country:US
Mailing Address - Phone:408-881-2772
Mailing Address - Fax:
Practice Address - Street 1:6826 S CENTINELA AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6301
Practice Address - Country:US
Practice Address - Phone:310-915-6100
Practice Address - Fax:310-915-0100
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist