MEDICARE: ELIEZER SOLTEZ VIRAY 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	9508	CO
2	225100000X	Physical Therapist	22997	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	97792224	OTHER		VISA PASSPORT NUMBER

General Provider Information

NPI Number	:	1770736829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIEZER SOLTEZ VIRAY PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	18302 CONTOUR RD
Second Line	:
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20877-2614
Country	:	US
Telephone Number	:	240-912-2960
Fax Number	:	301-944-0097

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

Provider Enumeration Date	:	11/02/2008
Last Update Date	:	08/08/2019

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Directions to “ ELIEZER SOLTEZ VIRAY PT” Practice Location

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