Provider Demographics
NPI:1114809555
Name:SOFER, ARI (PTA)
Entity type:Individual
Prefix:
First Name:ARI
Middle Name:
Last Name:SOFER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5546
Mailing Address - Country:US
Mailing Address - Phone:201-232-1501
Mailing Address - Fax:
Practice Address - Street 1:2730 WILSHIRE BLVD STE 533
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4751
Practice Address - Country:US
Practice Address - Phone:310-273-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA6096225200000X
NJ40QB00405200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant