MEDICARE: MRUGESHKUMAR ASHVINBHAI SONI PT

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	172V00000X	Community Health Worker	5501014107	MI
2	225100000X	Physical Therapist	1256225	TX

General Provider Information

NPI Number	:	1184052987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRUGESHKUMAR ASHVINBHAI SONI PT

Provider Business Mailing Address
First Line	:	3608 COLDSTREAM DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-1256
Country	:	US
Telephone Number	:	248-590-5045
Fax Number	:

Provider Business Practice Location Address
First Line	:	3608 COLDSTREAM DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-1256
Country	:	US
Telephone Number	:	248-590-5045
Fax Number	:

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

Provider Enumeration Date	:	10/15/2013
Last Update Date	:	04/21/2023

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