Provider Demographics
NPI:1013395920
Name:SOROKOS, NICK JAMES (LPTA)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:JAMES
Last Name:SOROKOS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 LASKIN RD
Mailing Address - Street 2:APT 229
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3060
Mailing Address - Country:US
Mailing Address - Phone:757-715-8320
Mailing Address - Fax:
Practice Address - Street 1:332 LASKIN RD
Practice Address - Street 2:APT 229
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-3060
Practice Address - Country:US
Practice Address - Phone:757-715-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604089225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant