Provider Demographics
NPI:1699931717
Name:AMOUDEH, SOPHIA F (MPT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:F
Last Name:AMOUDEH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 HAVEN AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5431
Mailing Address - Country:US
Mailing Address - Phone:909-484-3801
Mailing Address - Fax:
Practice Address - Street 1:9190 HAVEN AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5431
Practice Address - Country:US
Practice Address - Phone:909-484-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist