Provider Demographics
NPI:1740332006
Name:SOLANO SPORTS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:SOLANO SPORTS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:707-449-3484
Mailing Address - Street 1:1350 BURTON DR STE 260
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3545
Mailing Address - Country:US
Mailing Address - Phone:707-449-3484
Mailing Address - Fax:707-449-1803
Practice Address - Street 1:1350 BURTON DR STE 260
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3545
Practice Address - Country:US
Practice Address - Phone:707-449-3484
Practice Address - Fax:707-449-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT206900Medicare PIN