Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 10237 | FL |
N | 2251G0304X | Physical Therapist - Geriatrics | PT 10237 | FL |
N | 2251H1300X | Human Factors | PT 10237 | FL |
N | 225XH1300X | Human Factors | PT 10237 | FL |
N | 2251N0400X | Physical Therapist - Neurology | PT 10237 | FL |
NPI | 1730352162 |
---|---|
Provider Name | Solano Fernandez Mercado |
First Address | Port Charlotte, FL 33952-3923 |
Second Address | Port Charlotte, FL 33952-3923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2008 |
Last Update Date | 07/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1568677938 | MEDICARE GROUP NPI # (01) | FL |
Y905U | MEDICARE PROVIDER # (01) | FL |