Provider Demographics
NPI:1952693673
Name:SOUMYA SEBASTIAN, FNU (PT)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:SOUMYA SEBASTIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7689 PALMILLA DR
Mailing Address - Street 2:APT # 1304
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 CONSTITUTION AVE NE
Practice Address - Street 2:REHAB DEPT
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6058
Practice Address - Country:US
Practice Address - Phone:202-543-4800
Practice Address - Fax:202-629-5467
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCPT871130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist