Basic Information
Provider Information
NPI: 1528276961
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOTO
FirstName: MANUEL
MiddleName:  
NamePrefix: DR.
NameSuffix: II
Credential: D.P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2531 ROCKY RIDGE RD
Address2: SUITE 101
City: VESTAVIA
State: AL
PostalCode: 352434415
CountryCode: US
TelephoneNumber: 2059787376
FaxNumber: 2059780861
Practice Location
Address1: 209 FITNESS WAY
Address2: SUITE D
City: ATHENS
State: AL
PostalCode: 356112451
CountryCode: US
TelephoneNumber: 2562339148
FaxNumber: 2562339164
Other Information
ProviderEnumerationDate: 05/18/2007
LastUpdateDate: 09/19/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT 25383CAN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000XPTH8122ALY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home