MEDICARE: JOHN-JUSTIN SOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT60861842	WA
2	225100000X	Physical Therapist	1287583	TX

General Provider Information

NPI Number	:	1083152292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN-JUSTIN SOY

Provider Business Mailing Address
First Line	:	10004 204TH AVE E
Second Line	:	STE 3100
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-6540
Country	:	US
Telephone Number	:	253-863-7510
Fax Number	:

Provider Business Practice Location Address
First Line	:	4242 HONDO PASS DR
Second Line	:	SUITE 110
City	:	EL PASO
State	:	TX
Zip	:	79904-1205
Country	:	US
Telephone Number	:	915-751-0599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	03/01/2019

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Directions to “ JOHN-JUSTIN SOY ” Practice Location

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