Provider Demographics
NPI:1689050973
Name:SOLLIE, KEISHA N (DPT)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:N
Last Name:SOLLIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1964
Mailing Address - Country:US
Mailing Address - Phone:320-217-8480
Mailing Address - Fax:320-217-8490
Practice Address - Street 1:901 3RD ST N
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1964
Practice Address - Country:US
Practice Address - Phone:320-217-8480
Practice Address - Fax:320-217-8490
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00135312251X0800X
MN104982251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic