Provider Demographics
NPI:1508526591
Name:SOULIAN, WILLIAM J (PTA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:SOULIAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5143 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-4441
Mailing Address - Country:US
Mailing Address - Phone:708-254-8991
Mailing Address - Fax:
Practice Address - Street 1:15430 WEST AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4661
Practice Address - Country:US
Practice Address - Phone:708-460-5494
Practice Address - Fax:708-226-2528
Is Sole Proprietor?:No
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160002524225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant