Healthcare Provider Details

I. General information

NPI: 1144804261
Provider Name (Legal Business Name): SOMA PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 32ND ST STE 1002D
ASTORIA NY
11102-1139
US

IV. Provider business mailing address

2408 32ND ST STE 1002D
ASTORIA NY
11102-1139
US

V. Phone/Fax

Practice location:
  • Phone: 718-734-2373
  • Fax: 718-734-2372
Mailing address:
  • Phone: 718-734-2373
  • Fax: 718-734-2372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE STAMBOULIS
Title or Position: CO-FOUNDER
Credential: PT, DPT
Phone: 718-734-2373