Provider Demographics
NPI:1700261542
Name:PELTON, SOPHIA ANN (DPT)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ANN
Last Name:PELTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 DUNN PL
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-7721
Mailing Address - Country:US
Mailing Address - Phone:908-507-8219
Mailing Address - Fax:
Practice Address - Street 1:3948 FOREST OAKS LANE
Practice Address - Street 2:BLDG. E
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9813
Practice Address - Country:US
Practice Address - Phone:919-563-1825
Practice Address - Fax:919-563-1833
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC346512Medicare Oscar/Certification