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General NPI Number Information
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NPI Number | 1396834172
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Entity Type | Individual
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Provider Name | MARY KAY SOLON PT
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1234 E DUPONT RD STE 7
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City | FORT WAYNE
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State | IN
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Zip | 46825-1545
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Country | US
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Telephone | 260-490-0940
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Fax | 260-490-5063
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Provider Business Mailing Address
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Address Line | 714 STRATTON RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-5441
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Country | US
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Telephone |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 05000775A
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License Number State | IN
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