Provider Demographics
NPI:1548704026
Name:HERR, SOPHIE REDFIELD (PT)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:REDFIELD
Last Name:HERR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:REDFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:96 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6769
Mailing Address - Country:US
Mailing Address - Phone:207-846-3013
Mailing Address - Fax:
Practice Address - Street 1:146 STATE HOUSE STA
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0146
Practice Address - Country:US
Practice Address - Phone:624-666-0207
Practice Address - Fax:624-666-1207
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400358142Medicare PIN