Healthcare Provider Details

I. General information

NPI: 1629808142
Provider Name (Legal Business Name): EDER SOLANO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 S PURCELL BLVD # 116
PUEBLO CO
81007-5083
US

IV. Provider business mailing address

279 S PURCELL BLVD # 116
PUEBLO CO
81007-5083
US

V. Phone/Fax

Practice location:
  • Phone: 719-527-0848
  • Fax: 719-471-4415
Mailing address:
  • Phone: 719-527-0848
  • Fax: 719-471-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: