Provider Demographics
NPI:1376182600
Name:SOUKUP, MICHAEL LEE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:SOUKUP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 THORNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-8608
Mailing Address - Country:US
Mailing Address - Phone:775-233-5281
Mailing Address - Fax:
Practice Address - Street 1:203 THORNWOOD CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-8608
Practice Address - Country:US
Practice Address - Phone:775-233-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist