Healthcare Provider Details

I. General information

NPI: 1699412684
Provider Name (Legal Business Name): SOPHIA HANNAH DEEN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6826 S CENTINELA AVE
CULVER CITY CA
90230-6301
US

IV. Provider business mailing address

1381 BAY RIDGE CT
SAN JOSE CA
95120-4560
US

V. Phone/Fax

Practice location:
  • Phone: 310-915-6100
  • Fax: 310-915-0100
Mailing address:
  • Phone: 408-881-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: