Provider Demographics
NPI:1912537804
Name:SOAR HOME THERAPY, LLC
Entity Type:Organization
Organization Name:SOAR HOME THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:YAQUBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-762-8195
Mailing Address - Street 1:1403 W PETERS COLONY RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2750
Mailing Address - Country:US
Mailing Address - Phone:972-762-8195
Mailing Address - Fax:
Practice Address - Street 1:1403 W PETERS COLONY RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2750
Practice Address - Country:US
Practice Address - Phone:972-762-8195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-20
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty