Provider Demographics
NPI:1649604521
Name:SOMYOO, NIPAPORN (DPT)
Entity type:Individual
Prefix:
First Name:NIPAPORN
Middle Name:
Last Name:SOMYOO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 E DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2425
Mailing Address - Country:US
Mailing Address - Phone:602-256-5656
Mailing Address - Fax:602-569-6119
Practice Address - Street 1:616 E. SOUTHERN AVE.
Practice Address - Street 2:102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85204-6867
Practice Address - Country:US
Practice Address - Phone:602-569-5656
Practice Address - Fax:602-569-5656
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ114268Medicaid