Provider Demographics
NPI:1376657031
Name:SOAR, INC.
Entity Type:Organization
Organization Name:SOAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DORMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-342-9575
Mailing Address - Street 1:2050 W MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0905
Mailing Address - Country:US
Mailing Address - Phone:605-342-9575
Mailing Address - Fax:605-342-9592
Practice Address - Street 1:2050 W MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0905
Practice Address - Country:US
Practice Address - Phone:605-342-9575
Practice Address - Fax:605-342-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5835130Medicaid
SD100604Medicare PIN
SD5835130Medicaid
SD100605Medicare PIN