Healthcare Provider Details

I. General information

NPI: 1801146121
Provider Name (Legal Business Name): JOHN R SALVA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 W INDUSTRIAL PARK DR SUITE 11
BLOOMINGTON IN
47404-2635
US

IV. Provider business mailing address

3509 S GLASGOW CIR
BLOOMINGTON IN
47403-7900
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-7529
  • Fax: 812-339-7529
Mailing address:
  • Phone: 812-269-2679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05009689A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: