MEDICARE: MR. ZACK TREVOR SOLOMON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	25751	CA
2	2251X0800X	Orthopedic Physical Therapist	25751	CA

General Provider Information

NPI Number	:	1124018981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZACK TREVOR SOLOMON PT

Provider Business Mailing Address
First Line	:	CMR 411 BOX 2899
Second Line	:
City	:	APO
State	:	AE
Zip	:	09112-0029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIT 28037
Second Line	:
City	:	APO
State	:	AE
Zip	:	09112-8037
Country	:	US
Telephone Number	:	314-590-2590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	10/31/2023

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Directions to “ MR. ZACK TREVOR SOLOMON PT” Practice Location

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