Healthcare Provider Details

I. General information

NPI: 1295653053
Provider Name (Legal Business Name): CHRISTIAN SALCEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 COUNTRY CLUB RD STE 200
JACKSONVILLE NC
28546-2404
US

IV. Provider business mailing address

655 S WILLOW ST STE 128
MANCHESTER NH
03103-5723
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-3828
  • Fax:
Mailing address:
  • Phone: 800-995-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5012
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP059620A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: