Individual
SOFIA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
10600 MASTIN ST, OVERLAND PARK, KS 66212-5723
(913) 681-0606
(913) 338-1311
Mailing address
PO BOX 741331, ATLANTA, GA 30374-1331
(913) 469-0503
(913) 469-5267
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-05528
KS
Other
Enumeration date
12/09/2016
Last updated
12/09/2016
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