Provider Demographics
NPI:1326610775
Name:SOMA, DIPESH
Entity Type:Individual
Prefix:
First Name:DIPESH
Middle Name:
Last Name:SOMA
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 1:412 TENNESSEE SHORT CUT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-1042
Mailing Address - Country:US
Mailing Address - Phone:931-510-2988
Mailing Address - Fax:
Practice Address - Street 1:315 OAK ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1728
Practice Address - Country:US
Practice Address - Phone:931-823-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant