Healthcare Provider Details

I. General information

NPI: 1144083080
Provider Name (Legal Business Name): TILLIE SALAZAR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TILLIE HEIM PT

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 W PAULINE WHITAKER PKWY STE 120
ROGERS AR
72758-7341
US

IV. Provider business mailing address

5001 W PAULINE WHITAKER PKWY STE 120
ROGERS AR
72758-7341
US

V. Phone/Fax

Practice location:
  • Phone: 479-202-0337
  • Fax: 479-202-0338
Mailing address:
  • Phone: 479-202-0337
  • Fax: 479-202-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5430
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5430
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number5430
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: