Provider Demographics
NPI:1558662270
Name:TZORTZIS, SOPHIA JESSICA (MED)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:JESSICA
Last Name:TZORTZIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1827
Mailing Address - Country:US
Mailing Address - Phone:978-921-1182
Mailing Address - Fax:
Practice Address - Street 1:3 HOOVER AVE
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2209
Practice Address - Country:US
Practice Address - Phone:978-406-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist