Provider Demographics
NPI:1316214455
Name:SOLOTOFF, JESSE PATRICK (DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:PATRICK
Last Name:SOLOTOFF
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 SW 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2641
Mailing Address - Country:US
Mailing Address - Phone:305-903-5470
Mailing Address - Fax:
Practice Address - Street 1:2349 SW 126TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2641
Practice Address - Country:US
Practice Address - Phone:305-903-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIC726ZMedicare PIN