Basic Information
| Provider Information | |||||||||
| NPI: | 1588106900 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SOLOMON | ||||||||
| FirstName: | DONNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9724 PEACOCK HILL CIR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891170248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669910900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 W ANN ARBOR TRL | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481701694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669910900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2016 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3403 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.