Provider Demographics
NPI:1770736829
Name:VIRAY, ELIEZER SOLTEZ (PT)
Entity type:Individual
Prefix:
First Name:ELIEZER
Middle Name:SOLTEZ
Last Name:VIRAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:
Practice Address - Street 1:18302 CONTOUR RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20877-2614
Practice Address - Country:US
Practice Address - Phone:240-912-2960
Practice Address - Fax:301-944-0097
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9508225100000X
MD22997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
97792224OtherVISA PASSPORT NUMBER