Provider Demographics
NPI:1992928675
Name:SOLIMAN, FADY MOUSA (PTA)
Entity type:Individual
Prefix:MR
First Name:FADY
Middle Name:MOUSA
Last Name:SOLIMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 KINGS COVE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1605
Mailing Address - Country:US
Mailing Address - Phone:317-490-5743
Mailing Address - Fax:317-818-0975
Practice Address - Street 1:1230 KINGS COVE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1605
Practice Address - Country:US
Practice Address - Phone:317-490-5743
Practice Address - Fax:317-818-0975
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003504A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant