Provider Demographics
NPI:1386776276
Name:SORIANO, ABRAHAM B (PT)
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:B
Last Name:SORIANO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4100 S MEDFORD DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5622
Mailing Address - Country:US
Mailing Address - Phone:936-633-6901
Mailing Address - Fax:936-633-6084
Practice Address - Street 1:5925 PHELAN BLVD
Practice Address - Street 2:SUITE I-2
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6253
Practice Address - Country:US
Practice Address - Phone:409-866-7147
Practice Address - Fax:409-866-7143
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-6352-7225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T5419OtherBCBS