Provider Demographics
NPI:1114481736
Name:KUNIHIRO, SORAIA (PTA)
Entity Type:Individual
Prefix:
First Name:SORAIA
Middle Name:
Last Name:KUNIHIRO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4132
Mailing Address - Country:US
Mailing Address - Phone:678-684-3872
Mailing Address - Fax:
Practice Address - Street 1:5610 NEW BERMUDA RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-4004
Practice Address - Country:US
Practice Address - Phone:678-384-3872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002296225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant