Provider Demographics
NPI:1649605916
Name:SOLOMON, STEFANIE DRISCOLL (DPT)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:DRISCOLL
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4604
Mailing Address - Country:US
Mailing Address - Phone:415-935-0868
Mailing Address - Fax:
Practice Address - Street 1:1628 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4604
Practice Address - Country:US
Practice Address - Phone:415-935-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ21382ZMedicare UPIN