Provider Demographics
NPI:1053727883
Name:CORPUZ, SOFIA T (DPT)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:T
Last Name:CORPUZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7560 GARDNER PARK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3414
Mailing Address - Country:US
Mailing Address - Phone:703-753-1005
Mailing Address - Fax:703-753-2207
Practice Address - Street 1:6325 MULTIPLEX DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5327
Practice Address - Country:US
Practice Address - Phone:571-932-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist