Provider Demographics
NPI:1346957966
Name:SOMA PHYSIO & REHAB CENTER LLC
Entity Type:Organization
Organization Name:SOMA PHYSIO & REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:HYUN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:678-926-3868
Mailing Address - Street 1:2800 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2531
Mailing Address - Country:US
Mailing Address - Phone:678-926-3868
Mailing Address - Fax:
Practice Address - Street 1:2800 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2531
Practice Address - Country:US
Practice Address - Phone:678-926-3868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty