Provider Demographics
NPI:1174962989
Name:MOVVA, SOUMYA
Entity type:Individual
Prefix:
First Name:SOUMYA
Middle Name:
Last Name:MOVVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COMMONS DR
Mailing Address - Street 2:#44
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4943
Mailing Address - Country:US
Mailing Address - Phone:517-755-7229
Mailing Address - Fax:
Practice Address - Street 1:50 COMMONS DR
Practice Address - Street 2:#44
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-4943
Practice Address - Country:US
Practice Address - Phone:517-755-7229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist