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General NPI Number Information
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NPI Number | 1154055143
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Entity Type | Organization
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Legal Business Name | SOMA VITA PHYSIO & WELLNESS LLC
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 775 MOUNTAIN BLVD STE 108
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City | WATCHUNG
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State | NJ
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Zip | 07069-6262
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Country | US
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Telephone | 516-591-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 153 OLD STIRLING RD
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City | WARREN
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State | NJ
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Zip | 07059-5829
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Country | US
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Telephone | 516-591-5544
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST / OWNER
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Name | DR. STELLA DIMITRAKAKIS
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Credential |
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Telephone | 516-591-5544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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