Healthcare Provider Details

I. General information

NPI: 1740106558
Provider Name (Legal Business Name): SOPHIA GILEVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CLINT MOORE RD
BOCA RATON FL
33496-2658
US

IV. Provider business mailing address

20124 OCEAN KEY DR
BOCA RATON FL
33498-4529
US

V. Phone/Fax

Practice location:
  • Phone: 561-994-0014
  • Fax:
Mailing address:
  • Phone: 561-990-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number44168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: