Provider Demographics
NPI:1750836029
Name:SOLONIKA, NIA (DPT)
Entity Type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:SOLONIKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NIA
Other - Middle Name:K
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3802 EASTSIDE HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-2224
Mailing Address - Country:US
Mailing Address - Phone:406-777-3096
Mailing Address - Fax:406-721-3956
Practice Address - Street 1:3804 EASTSIDE HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2224
Practice Address - Country:US
Practice Address - Phone:406-777-3523
Practice Address - Fax:406-777-7042
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1750836029Medicaid