Provider Demographics
NPI:1124721253
Name:BIGOS, SOPHIA YVONNE (LMT)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:YVONNE
Last Name:BIGOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13806 FELIX WILL RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2432
Mailing Address - Country:US
Mailing Address - Phone:813-858-3129
Mailing Address - Fax:
Practice Address - Street 1:12950 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7459
Practice Address - Country:US
Practice Address - Phone:813-858-3129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA101492225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist