Provider Demographics
NPI:1154646115
Name:LEAN, SOFIA R (PT)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:R
Last Name:LEAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:R
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:1801 W MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1291
Practice Address - Country:US
Practice Address - Phone:517-264-6141
Practice Address - Fax:517-263-5786
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist