Provider Demographics
NPI:1790753424
Name:IVY, SOPHIE JEAN (PT)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:JEAN
Last Name:IVY
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 1:2802 CHALET KNOLLS LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0637
Mailing Address - Country:US
Mailing Address - Phone:512-826-0703
Mailing Address - Fax:
Practice Address - Street 1:21938 ROYAL MONTREAL DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:281-944-0001
Practice Address - Fax:281-944-0002
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist