Provider Demographics
NPI:1942529888
Name:SOODA, PALLAVI ANNAPPA (BPT, PPMPT)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:ANNAPPA
Last Name:SOODA
Suffix:
Gender:F
Credentials:BPT, PPMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 AIRLINE RD STE A9
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2644
Mailing Address - Country:US
Mailing Address - Phone:361-853-6500
Mailing Address - Fax:361-853-6501
Practice Address - Street 1:2222 AIRLINE RD STE A9
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2644
Practice Address - Country:US
Practice Address - Phone:361-853-6500
Practice Address - Fax:361-853-6501
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010240A225100000X
MI5501014739225100000X
TX1306415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX395083401Medicaid