Provider Demographics
NPI:1306934856
Name:AMOLI, SARA SOGOL (MPT, CSCS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:SOGOL
Last Name:AMOLI
Suffix:
Gender:F
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 KEEL DR
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1239
Mailing Address - Country:US
Mailing Address - Phone:949-394-8768
Mailing Address - Fax:
Practice Address - Street 1:1124 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6760
Practice Address - Country:US
Practice Address - Phone:949-394-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267922251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26792OtherPHYSICAL THERAPY LICENSE