Provider Demographics
NPI:1740554682
Name:FONG, SOPHIA (DPT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:FONG
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 1:1755 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4419
Mailing Address - Country:US
Mailing Address - Phone:646-515-9489
Mailing Address - Fax:
Practice Address - Street 1:2480 MISSION ST
Practice Address - Street 2:331
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2468
Practice Address - Country:US
Practice Address - Phone:415-282-6490
Practice Address - Fax:415-282-6491
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist