Healthcare Provider Details

I. General information

NPI: 1629902390
Provider Name (Legal Business Name): SOPHIE LOE THERAPEUTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 PROVINCE RD.
STRAFFORD NH
03884
US

IV. Provider business mailing address

134 EAST ST
CARLISLE MA
01741-1105
US

V. Phone/Fax

Practice location:
  • Phone: 339-333-0960
  • Fax:
Mailing address:
  • Phone: 339-333-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: REAGAN LYNN GAGNON
Title or Position: OWNER
Credential: PA-C
Phone: 415-509-4237