Provider Demographics
NPI:1255777959
Name:RODRIGUES, SOPHIA (BPTH, DPT)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:BPTH, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-0159
Mailing Address - Country:US
Mailing Address - Phone:909-556-2190
Mailing Address - Fax:
Practice Address - Street 1:2777 JEFFERSON DAVIS HWY, SUITE 109
Practice Address - Street 2:PERFORMANCE PHYSICAL THERAPY
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:540-318-8615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207903225100000X
NY035537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist