Provider Demographics
NPI:1992795173
Name:CADDAUAN, SOLOMON MEDRANO (PT)
Entity type:Individual
Prefix:MR
First Name:SOLOMON
Middle Name:MEDRANO
Last Name:CADDAUAN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:388 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3623
Mailing Address - Country:US
Mailing Address - Phone:914-481-8777
Mailing Address - Fax:914-481-8780
Practice Address - Street 1:388 WESTCHESTER AVE
Practice Address - Street 2:SUITE 1N
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3623
Practice Address - Country:US
Practice Address - Phone:914-481-8777
Practice Address - Fax:914-481-8780
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0145622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q39611Medicare ID - Type Unspecified