MEDICARE: SANDRA SOLES

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	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1738	OTHER	SC	LICENSE#

General Provider Information

NPI Number	:	1992815633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA SOLES

Provider Business Mailing Address
First Line	:	504 YORKTOWN CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3113
Country	:	US
Telephone Number	:	843-903-7932
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 HIGHWAY 17 N
Second Line	:	STE A
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-6012
Country	:	US
Telephone Number	:	843-238-9542
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ SANDRA SOLES ” Practice Location

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