Provider Demographics
NPI:1861213191
Name:SOZO PERFORMANCE THERAPY LLC
Entity type:Organization
Organization Name:SOZO PERFORMANCE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-622-9970
Mailing Address - Street 1:75-5660 KOPIKO ST STE C7 PMB 524
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3122
Mailing Address - Country:US
Mailing Address - Phone:256-622-9970
Mailing Address - Fax:
Practice Address - Street 1:75-5597 PALANI RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1661
Practice Address - Country:US
Practice Address - Phone:256-622-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty