Provider Demographics
NPI:1821295957
Name:SOLDEVILLA, AGRIPINO LATANAFRANCIA (PT)
Entity Type:Individual
Prefix:MR
First Name:AGRIPINO
Middle Name:LATANAFRANCIA
Last Name:SOLDEVILLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:LATANAFRANCIA
Other - Last Name:SOLDEVILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:619 CROSSINGS CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5465
Mailing Address - Country:US
Mailing Address - Phone:270-320-5949
Mailing Address - Fax:
Practice Address - Street 1:1561 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3238
Practice Address - Country:US
Practice Address - Phone:270-842-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY185224Medicaid