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General NPI Number Information
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NPI Number | 1013225002
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Entity Type | Individual
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Provider Name | SOURACHACK STEVE SANANIKONE DPT
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Gender | Male
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 5151 KATY FWY SUITE 305
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City | HOUSTON
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State | TX
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Zip | 77007-2260
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Country | US
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Telephone | 713-562-1031
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Fax |
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Provider Business Mailing Address
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Address Line | 13202 BRIAR FOREST DR APT. # 1108
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City | HOUSTON
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State | TX
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Zip | 77077-2434
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Country | US
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Telephone | 443-235-6410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1200953
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License Number State | TX
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