Healthcare Provider Details

I. General information

NPI: 1871692855
Provider Name (Legal Business Name): CARLOS E SALCEDO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7968 ESSEN PARK
BATON ROUGE LA
70809-7439
US

IV. Provider business mailing address

15327 SPRINGWOOD AVE
BATON ROUGE LA
70817-1552
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-6700
  • Fax:
Mailing address:
  • Phone: 225-751-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 2663
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: