Healthcare Provider Details

I. General information

NPI: 1235126509
Provider Name (Legal Business Name): JOSEPH MICHAEL SALAZAR ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14455 CLAY TERRACE BLVD
CARMEL IN
46032-3605
US

IV. Provider business mailing address

14455 CLAY TERRACE BLVD
CARMEL IN
46032-3605
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-5795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36000721A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: