Healthcare Provider Details

I. General information

NPI: 1639308166
Provider Name (Legal Business Name): SOPHIA MASRI PT, DPM, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BARRACUDA LN
KEY LARGO FL
33037-3733
US

IV. Provider business mailing address

2900 SW 79TH AVE
MIAMI FL
33155-2507
US

V. Phone/Fax

Practice location:
  • Phone: 789-348-1751
  • Fax: 786-901-8330
Mailing address:
  • Phone: 786-348-1751
  • Fax: 786-901-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006454
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number006454
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number006454
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number006454
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006454
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number006454
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19364
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023385
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number19364
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number19364
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number19364
License Number StateFL
# 12
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number19364
License Number StateFL
# 13
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3538
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: