Provider Demographics
NPI:1093228512
Name:SOLT, TANYA ASHLEY (LMT MA63082)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ASHLEY
Last Name:SOLT
Suffix:
Gender:F
Credentials:LMT MA63082
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:ASHLEY
Other - Last Name:SOLT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT MA63082
Mailing Address - Street 1:2319 DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-4846
Mailing Address - Country:US
Mailing Address - Phone:239-682-2779
Mailing Address - Fax:
Practice Address - Street 1:2319 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-4846
Practice Address - Country:US
Practice Address - Phone:239-682-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63082225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist