Provider Demographics
NPI:1215713011
Name:MARTIN, SOPHIE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:MARIE
Last Name:MARTIN
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 1:2170 S MCCLELLAND ST APT 314
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1017
Mailing Address - Country:US
Mailing Address - Phone:805-285-8302
Mailing Address - Fax:
Practice Address - Street 1:2170 S MCCLELLAND ST APT 314
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1017
Practice Address - Country:US
Practice Address - Phone:805-285-8302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13532425-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist