Healthcare Provider Details

I. General information

NPI: 1700840543
Provider Name (Legal Business Name): LUZEL SOLAS TANCINCO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUZEL DURON SOLAS

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 RIVERFRONT DR
LITTLE ROCK AR
72202
US

IV. Provider business mailing address

1600 RIVERFRONT DR
LITTLE ROCK AR
72202
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-6965
  • Fax: 501-603-0675
Mailing address:
  • Phone: 501-663-6965
  • Fax: 501-603-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2128
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT2128
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT2128
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: