Provider Demographics
NPI:1083152292
Name:SOY, JOHN-JUSTIN
Entity Type:Individual
Prefix:
First Name:JOHN-JUSTIN
Middle Name:
Last Name:SOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 204TH AVE E
Mailing Address - Street 2:STE 3100
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6540
Mailing Address - Country:US
Mailing Address - Phone:253-863-7510
Mailing Address - Fax:
Practice Address - Street 1:4242 HONDO PASS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-1205
Practice Address - Country:US
Practice Address - Phone:915-751-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60861842225100000X
TX1287583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist