Provider Demographics
NPI:1902858046
Name:SOLOLA, CLEMENTINA NKECHI (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CLEMENTINA
Middle Name:NKECHI
Last Name:SOLOLA
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 1:3013 HERMES DR
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1468
Mailing Address - Country:US
Mailing Address - Phone:773-233-7800
Mailing Address - Fax:773-233-7808
Practice Address - Street 1:1402 W 103RD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2953
Practice Address - Country:US
Practice Address - Phone:773-233-7800
Practice Address - Fax:773-233-7808
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9437883OtherPRIVATE HEALTHCARE SYSTEM
IL7618603Medicare UPIN
ILK07868Medicare UPIN
ILP00163861Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IL9437883OtherPRIVATE HEALTHCARE SYSTEM
IL2732361Medicare UPIN