Healthcare Provider Details

I. General information

NPI: 1831134634
Provider Name (Legal Business Name): MARKIAN L SONEVYTSKY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3276 WASHINGTON RD
PARLIN NJ
08859-1676
US

IV. Provider business mailing address

1180 RARITAN RD PO BOX 1014
CLARK NJ
07066-1311
US

V. Phone/Fax

Practice location:
  • Phone: 732-238-8484
  • Fax:
Mailing address:
  • Phone: 732-855-9751
  • Fax: 732-855-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00956500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number0040QA00956500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number0040QA00956500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2251H1300X
TaxonomyHuman Factors Physical Therapist
License Number0040QA00956500
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number0040QA00956500
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0040QA00956500
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number0040QA00956500
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA00956500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: