=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245058361
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOAR PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2024
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 166 CLEMENS AVE
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78130-5613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-214-6806
-----------------------------------------------------
Fax | 830-215-4980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 166 CLEMENS AVE
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78130-5613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-214-6806
-----------------------------------------------------
Fax | 830-215-4980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NICOLE STUART
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 214-412-4408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------