Provider Demographics
NPI:1982237772
Name:KANAKARIS, SOPHIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:KANAKARIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:GRECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 DALLAS PKWY STE 290
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7493
Mailing Address - Country:US
Mailing Address - Phone:945-260-0010
Mailing Address - Fax:
Practice Address - Street 1:4435 EASTGATE MALL STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1980
Practice Address - Country:US
Practice Address - Phone:858-587-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296962225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA296962OtherCOMMERCIAL, PPO, PRIVATE