Provider Demographics
NPI:1295958924
Name:SOLLEY, CHRISTINA RUTH
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RUTH
Last Name:SOLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-2523
Mailing Address - Country:US
Mailing Address - Phone:432-580-4752
Mailing Address - Fax:
Practice Address - Street 1:818 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-2808
Practice Address - Country:US
Practice Address - Phone:432-337-4649
Practice Address - Fax:432-337-0354
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2016143225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant