MEDICARE: SOLOMA PT PC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1891574224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLOMA PT PC

Provider Business Mailing Address
First Line	:	8724 16TH AVE APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4526
Country	:	US
Telephone Number	:	929-502-8523
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 WILLIAMSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1606
Country	:	US
Telephone Number	:	347-657-1123
Fax Number	:

Authorized Official
Title or Position	:	HEAD
Name	:	MAHMOUD SOLOMA
Credential	:	PT,DPT
Telephone Number	:	929-502-8523

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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