Healthcare Provider Details

I. General information

NPI: 1992815633
Provider Name (Legal Business Name): SANDRA SOLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 HIGHWAY 17 N STE A
SURFSIDE BEACH SC
29575-6012
US

IV. Provider business mailing address

504 YORKTOWN CT
MYRTLE BEACH SC
29579-3113
US

V. Phone/Fax

Practice location:
  • Phone: 843-238-9542
  • Fax:
Mailing address:
  • Phone: 843-903-7932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: