Provider Demographics
NPI:1003692393
Name:SOLITUDE PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:SOLITUDE PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:307-254-1895
Mailing Address - Street 1:14527 W SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2028
Mailing Address - Country:US
Mailing Address - Phone:307-254-1895
Mailing Address - Fax:
Practice Address - Street 1:14527 W SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2028
Practice Address - Country:US
Practice Address - Phone:307-254-1895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty