Basic Information
| Provider Information | |||||||||
| NPI: | 1144804261 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOMA PHYSICAL AND OCCUPATIONAL THERAPY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2408 32ND ST STE 1002D | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111021139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187342373 | ||||||||
| FaxNumber: | 7187342372 | ||||||||
| Practice Location | |||||||||
| Address1: | 2408 32ND ST STE 1002D | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111021139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187342373 | ||||||||
| FaxNumber: | 7187342372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2021 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | STAMBOULIS | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-FOUNDER | ||||||||
| AuthorizedOfficialTelephone: | 7187342373 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.