Provider Demographics
NPI:1356889729
Name:SOLOMON, MARIE MAZZOLA (RPT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:MAZZOLA
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7732 WORTHING ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6448
Mailing Address - Country:US
Mailing Address - Phone:203-530-6926
Mailing Address - Fax:
Practice Address - Street 1:7732 WORTHING ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6448
Practice Address - Country:US
Practice Address - Phone:203-530-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12860832251P0200X
CT0030612251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics