Healthcare Provider Details

I. General information

NPI: 1932039765
Provider Name (Legal Business Name): SOPHIE ALEXANDRA SULESKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 FRANKLIN RD SW UNIT B
ROANOKE VA
24014-5258
US

IV. Provider business mailing address

4208 FRANKLIN RD SW UNIT B
ROANOKE VA
24014-5258
US

V. Phone/Fax

Practice location:
  • Phone: 540-446-0189
  • Fax:
Mailing address:
  • Phone: 540-446-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: