Provider Demographics
NPI:1366780215
Name:SOFRANAC, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:SOFRANAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-1230 MAMALAHOA HWY
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8318
Mailing Address - Country:US
Mailing Address - Phone:808-329-0591
Mailing Address - Fax:808-329-2066
Practice Address - Street 1:65-1230 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8318
Practice Address - Country:US
Practice Address - Phone:808-329-0591
Practice Address - Fax:808-329-2066
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist