Provider Demographics
NPI:1386869022
Name:SOLOMON, NICANOR MABUTAS JR (PT)
Entity type:Individual
Prefix:MR
First Name:NICANOR
Middle Name:MABUTAS
Last Name:SOLOMON
Suffix:JR
Gender:M
Credentials:PT
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Mailing Address - Street 1:427 BRIGHTON TER
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:PA
Mailing Address - Zip Code:19043-1107
Mailing Address - Country:US
Mailing Address - Phone:610-583-4059
Mailing Address - Fax:610-583-4059
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:800-879-4471
Practice Address - Fax:610-834-7525
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAPT015514225100000X
NJ40QA00734700225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist