Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | C.PED.#1258 | CA |
N | 225100000X | Physical Therapist | #1414 | NV |
Y | 225100000X | Physical Therapist | CA#24879 | CA |
NPI | 1598098139 |
---|---|
Provider Name | Ryan Michael Solberg |
First Address | Truckee, CA 96161 |
Second Address | Truckee, CA 96161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2009 |
Last Update Date | 15/09/2009 |