Provider Demographics
NPI:1336434802
Name:SOLTES, EVANGELINE VELASQUEZ (PT)
Entity type:Individual
Prefix:MRS
First Name:EVANGELINE
Middle Name:VELASQUEZ
Last Name:SOLTES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9154 LEICESTER WAY
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-7133
Mailing Address - Country:US
Mailing Address - Phone:630-229-8745
Mailing Address - Fax:
Practice Address - Street 1:9154 LEICESTER WAY
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-7133
Practice Address - Country:US
Practice Address - Phone:630-229-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist