Provider Demographics
NPI:1265531024
Name:SOLESKY, THERESA TRACEY (PT)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:TRACEY
Last Name:SOLESKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VIRGINIA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-5882
Mailing Address - Country:US
Mailing Address - Phone:772-466-9173
Mailing Address - Fax:772-466-9728
Practice Address - Street 1:900 VIRGINIA AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5882
Practice Address - Country:US
Practice Address - Phone:772-466-9173
Practice Address - Fax:772-466-9728
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8915Medicare ID - Type Unspecified