Active NPI
Sophia Formosa
- Physical Therapy Assistant
- Garberville, CA
National Provider Identifier
1801788542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 53577
- Practice address
- 733 Cedar St
Garberville, CA 95542-3201 - Phone
- (707) 923-3921
- NPI assigned
- Jul 17, 2025
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 53577 | CA | Primary |
Addresses
Primary practice location
733 Cedar St
Garberville, CA 95542-3201
Mailing address
PO Box 92
Whitethorn, CA 95589-0092
Phone (415) 490-8308
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 |
|---|---|---|---|
| 53577 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752710400000",
"number": "1801788542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 92",
"city": "WHITETHORN",
"state": "CA",
"postal_code": "955890092",
"telephone_number": "415-490-8308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "733 CEDAR ST",
"city": "GARBERVILLE",
"state": "CA",
"postal_code": "955423201",
"telephone_number": "707-923-3921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMOSA",
"first_name": "SOPHIA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-07-17",
"last_updated": "2025-07-17",
"certification_date": "2025-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "53577",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garberville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.