Healthcare Provider Details

I. General information

NPI: 1588663181
Provider Name (Legal Business Name): JOHN ROBERT SALLADE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 LAWNDALE RD.
FLEETWOOD PA
19522
US

IV. Provider business mailing address

36 LAWNDALE RD
WYOMISSING PA
19610-1974
US

V. Phone/Fax

Practice location:
  • Phone: 619-944-7626
  • Fax: 610-944-8079
Mailing address:
  • Phone: 610-372-2859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPA005092
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: