Healthcare Provider Details

I. General information

NPI: 1689215394
Provider Name (Legal Business Name): BENJAMIN C. SALINAS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 S PURCELL BLVD # 116
PUEBLO CO
81007-5083
US

IV. Provider business mailing address

PO BOX 2860
ALAMOGORDO NM
88311-2860
US

V. Phone/Fax

Practice location:
  • Phone: 719-547-2481
  • Fax: 719-471-4415
Mailing address:
  • Phone: 575-439-1397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5599
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP014938T
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: