MEDICARE: CHRISTOPHER RHETT SOLTAS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	1104364

General Provider Information

NPI Number	:	1215372149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER RHETT SOLTAS PA-C

Provider Business Mailing Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-0001
Country	:	US
Telephone Number	:	256-968-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-4504
Country	:	US
Telephone Number	:	256-968-1110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	06/09/2022

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