Provider Demographics
NPI:1396514022
Name:SOSA, FAITH LYDIA (PT)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:LYDIA
Last Name:SOSA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N ESTRELLA PKWY STE 50
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9279
Mailing Address - Country:US
Mailing Address - Phone:623-882-2992
Mailing Address - Fax:623-925-4923
Practice Address - Street 1:750 N ESTRELLA PKWY STE 50
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9279
Practice Address - Country:US
Practice Address - Phone:623-882-2992
Practice Address - Fax:623-925-4923
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-033370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ209808Medicaid