Provider Demographics
NPI:1790255156
Name:HAUPT, SOLANA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SOLANA
Middle Name:
Last Name:HAUPT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 CRENSHAW DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-8326
Mailing Address - Country:US
Mailing Address - Phone:503-729-2394
Mailing Address - Fax:
Practice Address - Street 1:8835 CRENSHAW DR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-8326
Practice Address - Country:US
Practice Address - Phone:503-729-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015396225100000X
MD26200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist