Healthcare Provider Details

I. General information

NPI: 1629906391
Provider Name (Legal Business Name): NICHOLAS SALCEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E MAIN ST
PLAINVILLE CT
06062-1968
US

IV. Provider business mailing address

47 N MAIN ST
WEST HARTFORD CT
06107-1926
US

V. Phone/Fax

Practice location:
  • Phone: 860-517-8885
  • Fax: 860-517-8884
Mailing address:
  • Phone: 860-409-4595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15380
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: