Provider Demographics
NPI:1790817104
Name:FERDINAND P SORONGON
Entity Type:Organization
Organization Name:FERDINAND P SORONGON
Other - Org Name:KANAWHA VALLEY PHYSICAL THERAPY CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:PADILLA
Authorized Official - Last Name:SORONGON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:304-546-7903
Mailing Address - Street 1:1313 DUNBAR AVE
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-2920
Mailing Address - Country:US
Mailing Address - Phone:304-768-3307
Mailing Address - Fax:304-768-3620
Practice Address - Street 1:1313 DUNBAR AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2920
Practice Address - Country:US
Practice Address - Phone:304-768-3307
Practice Address - Fax:304-768-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV000937261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy