Provider Demographics
NPI:1376948109
Name:AGYEMAN, SOLOMON (DPT)
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:
Last Name:AGYEMAN
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 1:8500 FRANCISCAN WOODS DR
Mailing Address - Street 2:APT. 922
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-5664
Mailing Address - Country:US
Mailing Address - Phone:703-677-5727
Mailing Address - Fax:
Practice Address - Street 1:610 SPARTA WOOD
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082
Practice Address - Country:US
Practice Address - Phone:478-240-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist