Provider Demographics
NPI:1578920799
Name:SOLE INNOVATIONS
Entity Type:Organization
Organization Name:SOLE INNOVATIONS
Other - Org Name:REBOUND MEDICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KULIFAJ
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOCP
Authorized Official - Phone:775-750-6772
Mailing Address - Street 1:301 HOT SPRINGS RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-1647
Mailing Address - Country:US
Mailing Address - Phone:775-849-0244
Mailing Address - Fax:
Practice Address - Street 1:10051 LAKE AVE
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0445
Practice Address - Country:US
Practice Address - Phone:530-587-7461
Practice Address - Fax:530-587-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C52332OtherBOC