MEDICARE: MR. CRAIG STEVEN SOLOMON PTA

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	A1791	MD

General Provider Information

NPI Number	:	1760512420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG STEVEN SOLOMON PTA

Provider Business Mailing Address
First Line	:	2153 ELM TREE LN
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-6310
Country	:	US
Telephone Number	:	301-603-8478
Fax Number	:	301-946-9164

Provider Business Practice Location Address
First Line	:	10605 CONCORD ST
Second Line	:	SUITE 201
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2504
Country	:	US
Telephone Number	:	301-929-0688
Fax Number	:	301-946-9164

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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