Provider Demographics
NPI:1265681456
Name:SOLIS THOMAS, JOANN MARIE (PTA, LMT)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:MARIE
Last Name:SOLIS THOMAS
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12366 CORPORAL CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-2259
Mailing Address - Country:US
Mailing Address - Phone:941-255-0957
Mailing Address - Fax:
Practice Address - Street 1:3417 TAMIAMI TRL STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8158
Practice Address - Country:US
Practice Address - Phone:941-624-6222
Practice Address - Fax:941-624-6821
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21381225200000X
FLMA28457225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist