Provider Demographics
NPI:1700024569
Name:SONAL MODI PT INC
Entity Type:Organization
Organization Name:SONAL MODI PT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-674-2022
Mailing Address - Street 1:1 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-2609
Mailing Address - Country:US
Mailing Address - Phone:201-674-2022
Mailing Address - Fax:201-750-2477
Practice Address - Street 1:1 ROSS AVE
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-2609
Practice Address - Country:US
Practice Address - Phone:201-674-2022
Practice Address - Fax:201-750-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00345400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty