Provider Demographics
NPI:1548974694
Name:CHIMENTI, SOPHIA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:CHIMENTI
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 IDLEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-3021
Mailing Address - Country:US
Mailing Address - Phone:631-871-3745
Mailing Address - Fax:
Practice Address - Street 1:6620 FLY RD STE 200
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-5076
Practice Address - Country:US
Practice Address - Phone:315-464-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0045232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer