MEDICARE: SOULECTIVE PELVIC HEALTH AND WELLNESS PLLC

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

General Provider Information

NPI Number	:	1164130886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOULECTIVE PELVIC HEALTH AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	332 S MICHIGAN AVE STE 121-S3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-4434
Country	:	US
Telephone Number	:	779-429-2590
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 S. MICHICAN AVE.
Second Line	:	STE 121-S3
City	:	CHICAGO
State	:	IL
Zip	:	60604-4691
Country	:	US
Telephone Number	:	779-429-2590
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. SONAM SAYANIA
Credential	:	PT, DPT
Telephone Number	:	779-429-2590

Provider Enumeration Date	:	11/10/2022
Last Update Date	:	04/14/2023

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