MEDICARE: SOPHIE LIA JOHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTL.0018927	CO

General Provider Information

NPI Number	:	1295431013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIE LIA JOHN

Provider Business Mailing Address
First Line	:	PO BOX 177
Second Line	:
City	:	IDAHO SPRINGS
State	:	CO
Zip	:	80452-0177
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22620 SE 4TH ST STE 240
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7375
Country	:	US
Telephone Number	:	425-200-0054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2023
Last Update Date	:	05/18/2026

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Directions to “ SOPHIE LIA JOHN ” Practice Location

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