Healthcare Provider Details

I. General information

NPI: 1528883816
Provider Name (Legal Business Name): DAVID ELIECER LOPEZ SALAMANCA PT, MSC EPIDEMIOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SW 148TH AVE STE 115
MIRAMAR FL
33027-4181
US

IV. Provider business mailing address

806 NW 156TH AVE
PEMBROKE PINES FL
33028-1517
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-7000
  • Fax:
Mailing address:
  • Phone: 954-993-5675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42561
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: