Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501002412 | MI |
N | 2251S0007X | Physical Therapist - Sports | 5501002412 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 5501002412 | MI |
NPI | 1043478134 |
---|---|
Provider Name | Dr. Kenneth Peter Soave |
First Address | Bingham Farms, MI 48025-4320 |
Second Address | Bingham Farms, MI 48025-4320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 27/05/2008 |