Healthcare Provider Details

I. General information

NPI: 1104974682
Provider Name (Legal Business Name): MS. AIMEE SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

IV. Provider business mailing address

PO BOX 306
GLENOLDEN PA
19036-0306
US

V. Phone/Fax

Practice location:
  • Phone: 484-454-8700
  • Fax: 484-454-8713
Mailing address:
  • Phone: 484-454-8700
  • Fax: 484-454-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC000077
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: