Provider Demographics
NPI:1730352162
Name:MERCADO, SOLANO FERNANDEZ (PT)
Entity type:Individual
Prefix:
First Name:SOLANO
Middle Name:FERNANDEZ
Last Name:MERCADO
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 1:2301 TAMIAMI TRL STE E
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-3923
Mailing Address - Country:US
Mailing Address - Phone:941-625-1252
Mailing Address - Fax:941-625-0616
Practice Address - Street 1:2301 TAMIAMI TRL
Practice Address - Street 2:SUITE E
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-3923
Practice Address - Country:US
Practice Address - Phone:941-625-1252
Practice Address - Fax:941-625-0616
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 10237225100000X, 2251G0304X, 2251H1300X, 2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman Factors
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1568677938OtherMEDICARE GROUP NPI #
FLY905UOtherMEDICARE PROVIDER #