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General NPI Number Information
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NPI Number | 1245722867
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Entity Type | Organization
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Legal Business Name | SOMA DYNAMICS PHYSICAL THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 5026 OCEANIA ST
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City | BAYSIDE
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State | NY
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Zip | 11364-1123
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Country | US
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Telephone | 718-598-0548
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Fax |
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Provider Business Mailing Address
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Address Line | 5026 OCEANIA ST
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City | BAYSIDE
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State | NY
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Zip | 11364-1123
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Country | US
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Telephone | 718-598-0548
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | PETER S PANAGOS
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Credential | PTA
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Telephone | 718-598-0548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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