Provider Demographics
NPI:1386852671
Name:SOTOODEH, SOHEILA TAYAB (PT)
Entity Type:Individual
Prefix:PROF
First Name:SOHEILA
Middle Name:TAYAB
Last Name:SOTOODEH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 KEYHOLE ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3282
Mailing Address - Country:US
Mailing Address - Phone:972-257-0773
Mailing Address - Fax:972-782-9268
Practice Address - Street 1:8615 FREEPORT PKWY
Practice Address - Street 2:SUITE225
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2576
Practice Address - Country:US
Practice Address - Phone:972-812-3299
Practice Address - Fax:972-812-3283
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176768282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital