Provider Demographics
NPI:1245722867
Name:SOMA DYNAMICS PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:SOMA DYNAMICS PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:PANAGOS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:718-598-0548
Mailing Address - Street 1:5026 OCEANIA ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1123
Mailing Address - Country:US
Mailing Address - Phone:718-598-0548
Mailing Address - Fax:
Practice Address - Street 1:5026 OCEANIA ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-1123
Practice Address - Country:US
Practice Address - Phone:718-598-0548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health