Provider Demographics
NPI:1467764746
Name:SOLOMON, KARISSA L (DPT)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:L
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:
Other - Last Name:BEECHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:100 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1501
Practice Address - Country:US
Practice Address - Phone:717-692-4708
Practice Address - Fax:717-692-5464
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT004026225100000X
PAPT020628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028716430083Medicaid
PA773031OtherMEDICARE