Healthcare Provider Details

I. General information

NPI: 1356325542
Provider Name (Legal Business Name): ERIK RICHARD SALLEY PT DPT MA OCS CMDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 MADISON ST STE 102
RIVERSIDE CA
92504-3785
US

IV. Provider business mailing address

3505 MADISON ST STE 102
RIVERSIDE CA
92504-3785
US

V. Phone/Fax

Practice location:
  • Phone: 951-329-3928
  • Fax: 951-374-0621
Mailing address:
  • Phone: 951-329-3928
  • Fax: 951-374-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number22669
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: