Active NPI
Sophanarith Am
- Massage Therapist
- Marblehead, MA
National Provider Identifier
1295521714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 17833
- Practice address
- 50 Doaks LN
Marblehead, MA 01945-3584 - Phone
- (617) 420-2041
- NPI assigned
- Apr 21, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 17833 | MA | Primary |
Addresses
Primary practice location
50 Doaks LN
Marblehead, MA 01945-3584
Mailing address
9 Victoria St
Revere, MA 02151-3911
Other practice location 1
137 Cabot St
Beverly, MA 01915-5144
Phone (617) 420-2041
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17833 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745193600000",
"number": "1295521714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 VICTORIA ST",
"city": "REVERE",
"state": "MA",
"postal_code": "021513911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 DOAKS LN",
"city": "MARBLEHEAD",
"state": "MA",
"postal_code": "019453584",
"telephone_number": "617-420-2041"
}
],
"practiceLocations": [
{
"address_1": "137 Cabot St",
"address_purpose": "LOCATION",
"city": "Beverly",
"state": "MA",
"postal_code": "019155144",
"country_code": "US",
"telephone_number": "617-420-2041",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "AM",
"first_name": "SOPHANARITH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-04-21",
"last_updated": "2025-04-21",
"certification_date": "2025-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MA",
"license": "17833",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marblehead, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.