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General NPI Number Information
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NPI Number | 1396033569
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Entity Type | Individual
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Provider Name | SOPHIA RUTH MAINES PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 2324 E CESAR CHAVEZ ST
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City | AUSTIN
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State | TX
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Zip | 78702-4604
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Country | US
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Telephone | 512-522-6447
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Fax |
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Provider Business Mailing Address
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Address Line | 520 KODIAK TRL
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City | CEDAR PARK
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State | TX
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Zip | 78613-4108
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Country | US
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Telephone | 512-429-2975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 19622
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1244873
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License Number State | TX
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