Provider Demographics
NPI:1629164264
Name:SONI, SEJAL S (MPT)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:S
Last Name:SONI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 GRACIE COURT
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548
Mailing Address - Country:US
Mailing Address - Phone:832-326-9118
Mailing Address - Fax:
Practice Address - Street 1:3816 S CLEAR CREEK
Practice Address - Street 2:SUITE B
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549
Practice Address - Country:US
Practice Address - Phone:254-699-3933
Practice Address - Fax:254-526-8604
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1153611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4528OtherBCBS
TX8T4528OtherBCBS