Provider Demographics
NPI:1538639307
Name:SORIANO-VALEROS, KARYL TUMANGUIL
Entity Type:Individual
Prefix:
First Name:KARYL
Middle Name:TUMANGUIL
Last Name:SORIANO-VALEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 MASON RIDGE CT NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9596
Mailing Address - Country:US
Mailing Address - Phone:231-557-9499
Mailing Address - Fax:
Practice Address - Street 1:1430 MONROE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4680
Practice Address - Country:US
Practice Address - Phone:616-685-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist