Provider Demographics
NPI:1184052987
Name:SONI, MRUGESHKUMAR ASHVINBHAI (PT)
Entity type:Individual
Prefix:
First Name:MRUGESHKUMAR
Middle Name:ASHVINBHAI
Last Name:SONI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 COLDSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-1256
Mailing Address - Country:US
Mailing Address - Phone:248-590-5045
Mailing Address - Fax:
Practice Address - Street 1:3608 COLDSTREAM DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-1256
Practice Address - Country:US
Practice Address - Phone:248-590-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014107172V00000X
TX1256225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No172V00000XOther Service ProvidersCommunity Health Worker