Provider Demographics
NPI:1760628168
Name:SOPPE, SUSAN LYNN (PT)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:LYNN
Last Name:SOPPE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25327 AVENUE STANFORD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1242
Mailing Address - Country:US
Mailing Address - Phone:661-295-2500
Mailing Address - Fax:661-257-0093
Practice Address - Street 1:25327 AVENUE STANFORD
Practice Address - Street 2:STE. 105
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1242
Practice Address - Country:US
Practice Address - Phone:661-295-2500
Practice Address - Fax:661-257-0093
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP.T. 17270172V00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No172V00000XOther Service ProvidersCommunity Health Worker