Provider Demographics
NPI:1083372437
Name:SOLOMON, JACQUELYN (DPT)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 INDIAN QUEEN LANE
Mailing Address - Street 2:APT. 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129
Mailing Address - Country:US
Mailing Address - Phone:347-263-0158
Mailing Address - Fax:
Practice Address - Street 1:790 E MARKET ST STE 290
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4891
Practice Address - Country:US
Practice Address - Phone:610-696-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist