| Soma Physical Therapy Inc | |
|
1740 La Costa Meadows Dr Ste 250 San Marcos CA 92078-2122 | |
| (760) 516-8900 | |
| (760) 410-6175 |
| Full Name | Soma Physical Therapy Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1740 La Costa Meadows Dr Ste 250, San Marcos, California |
| Authorized Official Name and Position | Adam Robert Pavlovich (OWNER/ PHYSICAL THERAPIST) |
| Authorized Official Contact | 6073412479 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soma Physical Therapy Inc 1245 San Pablo Dr San Marcos CA 92078-4816 | Soma Physical Therapy Inc 1740 La Costa Meadows Dr Ste 250 San Marcos CA 92078-2122 Ph: (760) 516-8900 |
| NPI Number | 1801548409 |
|---|---|
| Provider Enumeration Date | 01/25/2022 |
| Last Update Date | 03/21/2023 |
| Certification Date | 03/21/2023 |
| Medicare PECOS PAC ID | 4385002781 |
|---|---|
| Medicare Enrollment ID | O20230616000447 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801548409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| 225100000X | Physical Therapist | (NU) | Secondary |
| Provider Name | Brandon Mendoza |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497211163 PECOS PAC ID: 6800207762 Enrollment ID: I20201124003114 |
| Provider Name | Adam Robert Pavlovich |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1992260632 PECOS PAC ID: 1658760533 Enrollment ID: I20211115002079 |
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