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General NPI Number Information
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NPI Number | 1255503330
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Entity Type | Individual
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Provider Name | MARY GRACE Y SOLIS-ALTAVAS P.T.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 5860 GOLDEN GATE PKWY
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City | NAPLES
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State | FL
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Zip | 34116-7459
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Country | US
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Telephone | 239-455-9525
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Fax |
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Provider Business Mailing Address
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Address Line | 3713 OAK HOLLOW DR
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City | NEWBERG
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State | OR
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Zip | 97132-7478
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Country | US
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Telephone | 503-554-9318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT23901
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License Number State | FL
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