Healthcare Provider Details

I. General information

NPI: 1003343062
Provider Name (Legal Business Name): SOMA POTENTIAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2017
Last Update Date: 05/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 MAHLON AVE
EUGENE OR
97401-8046
US

IV. Provider business mailing address

3601 MAHLON AVE
EUGENE OR
97401-8046
US

V. Phone/Fax

Practice location:
  • Phone: 773-351-5092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number60663
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JODI JAMES
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 773-351-5092