Provider Demographics
NPI:1760673230
Name:PHILIP, SOPHIAMMA JOBY
Entity Type:Individual
Prefix:MRS
First Name:SOPHIAMMA
Middle Name:JOBY
Last Name:PHILIP
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 1:2314 E MICHAEL MANOR LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4337
Mailing Address - Country:US
Mailing Address - Phone:847-797-1992
Mailing Address - Fax:847-797-1992
Practice Address - Street 1:2314 E MICHAEL MANOR LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4337
Practice Address - Country:US
Practice Address - Phone:847-797-1992
Practice Address - Fax:847-797-1992
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist