Sophia Donnellon, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

4455 24TH Ave
Fort Gratiot, MI 48059-4516

Phone

(810) 357-4967

NPI assigned

Aug 26, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Sophia Kincaid Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Michigan, LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Fenton, MI
  • NPI 1104337120

  Physical Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1366276115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 EMMETT RD",
            "city": "BROCKWAY",
            "state": "MI",
            "postal_code": "480973019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480594516",
            "telephone_number": "810-357-4967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLON",
        "first_name": "SOPHIA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-26",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SOPHIA",
            "last_name": "KINCAID",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashley Denby, LMT
• Kaileigh Destevens-Carpenter
• Colleen Dewan, RN
• Abigail Ruth Dewitte
• Jocelyn Dokulil
• Dakota Donovan
• Bridgette Douglas
• Amanda Lynn Doyle, LMT
• Dr Shores & Associates Optometrist Inc
• Dr. Eldib Fort Gratiot, PLLC

• Physical Therapist in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.