Provider Demographics
NPI:1073798534
Name:SOLIS, KYLIE (PT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:SOLIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:RAYMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:534 E PINE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5536
Mailing Address - Country:US
Mailing Address - Phone:209-463-5800
Mailing Address - Fax:209-463-5900
Practice Address - Street 1:534 E PINE ST
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5536
Practice Address - Country:US
Practice Address - Phone:209-463-5800
Practice Address - Fax:209-463-5900
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist