Healthcare Provider Details

I. General information

NPI: 1154363422
Provider Name (Legal Business Name): SOPHIA A RISORTO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68860 PEREZ RD STE E2
CATHEDRAL CITY CA
92234-7248
US

IV. Provider business mailing address

68860 PEREZ RD STE E2
CATHEDRAL CITY CA
92234-7248
US

V. Phone/Fax

Practice location:
  • Phone: 760-770-6651
  • Fax: 760-770-6651
Mailing address:
  • Phone: 760-770-6651
  • Fax: 760-770-6651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT12093
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number10584
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: