Provider Demographics
NPI:1851678361
Name:DIAGNOSTIC AUTHORITY PT, PLLC
Entity Type:Organization
Organization Name:DIAGNOSTIC AUTHORITY PT, PLLC
Other - Org Name:ADAPTIVE PT, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:906-483-4800
Mailing Address - Street 1:901 W SHARON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1964
Mailing Address - Country:US
Mailing Address - Phone:906-483-4800
Mailing Address - Fax:
Practice Address - Street 1:901 W SHARON AVE STE 1
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1964
Practice Address - Country:US
Practice Address - Phone:906-483-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013593261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5341001OtherMEDICARE INDIVIDUAL