Provider Demographics
NPI:1932450202
Name:SONI, MITESHKUMAR DEEPAKBHAI (PT)
Entity Type:Individual
Prefix:
First Name:MITESHKUMAR
Middle Name:DEEPAKBHAI
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 1:2379 SHAKER LN
Mailing Address - Street 2:APT D
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-3162
Mailing Address - Country:US
Mailing Address - Phone:765-337-1762
Mailing Address - Fax:
Practice Address - Street 1:301 W ESSEX ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1755
Practice Address - Country:US
Practice Address - Phone:765-482-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010063A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist