Provider Demographics
NPI:1740959212
Name:LEBOWITZ, SOPHIE RENSON
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:RENSON
Last Name:LEBOWITZ
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 1:2321 LAGUNA CIR APT 1109
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1080
Mailing Address - Country:US
Mailing Address - Phone:305-423-9641
Mailing Address - Fax:
Practice Address - Street 1:2321 LAGUNA CIR APT 1109
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-1080
Practice Address - Country:US
Practice Address - Phone:305-423-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA97515225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist