Provider Demographics
NPI:1578699401
Name:CHARLES, SOLANGE VIVIANNE (PTA)
Entity Type:Individual
Prefix:
First Name:SOLANGE
Middle Name:VIVIANNE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10581 SW 155TH CT
Mailing Address - Street 2:APTO. 1217
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3537
Mailing Address - Country:US
Mailing Address - Phone:305-385-4507
Mailing Address - Fax:305-385-4507
Practice Address - Street 1:10581 SW 155 CT
Practice Address - Street 2:APTO. 1217
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196
Practice Address - Country:US
Practice Address - Phone:305-385-4507
Practice Address - Fax:305-385-4507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20812225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant