Provider Demographics
NPI:1083030720
Name:VAIDYA, SONAL (PT)
Entity type:Individual
Prefix:
First Name:SONAL
Middle Name:
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N WATTERS RD
Mailing Address - Street 2:STE 105
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5536
Mailing Address - Country:US
Mailing Address - Phone:972-424-5840
Mailing Address - Fax:972-423-9427
Practice Address - Street 1:700 ALMA DR
Practice Address - Street 2:SUITE 135
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8807
Practice Address - Country:US
Practice Address - Phone:972-424-5840
Practice Address - Fax:972-423-9427
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1236448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist