Healthcare Provider Details

I. General information

NPI: 1730477456
Provider Name (Legal Business Name): SOMA PHYSICAL THERAPY AND REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RESERVOIR ST SUITE 32
NEEDHAM MA
02494-3149
US

IV. Provider business mailing address

220 RESERVOIR ST SUITE 32
NEEDHAM MA
02494-3149
US

V. Phone/Fax

Practice location:
  • Phone: 781-400-1236
  • Fax:
Mailing address:
  • Phone: 781-400-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number901
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JAMES RAY RUETENIK
Title or Position: OCS
Credential: P.T.
Phone: 781-400-1236