Healthcare Provider Details

I. General information

NPI: 1225334808
Provider Name (Legal Business Name): ADRIANA SALAS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4532 WEST GATE BOULEVARD SUITE 100
AUSTIN TX
78745
US

IV. Provider business mailing address

17325 BELL NORTH DR SUITE 2-B
SCHERTZ TX
78154-3368
US

V. Phone/Fax

Practice location:
  • Phone: 512-892-7337
  • Fax: 512-892-7339
Mailing address:
  • Phone: 210-590-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1202743
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: