Provider Demographics
NPI:1902289135
Name:SOPER, MONICA (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:SOPER
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 1:6363 DALLAS PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9683
Mailing Address - Country:US
Mailing Address - Phone:972-250-5777
Mailing Address - Fax:855-271-2435
Practice Address - Street 1:6363 DALLAS PKWY STE 207
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9683
Practice Address - Country:US
Practice Address - Phone:972-250-5777
Practice Address - Fax:855-271-2435
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1259987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192079501Medicaid
TX192079501Medicaid