=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023870771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISABEL SALAZAR DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2024
-----------------------------------------------------
Last Update Date | 01/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 LAGUNA ST
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-441-5258
-----------------------------------------------------
Fax | 305-446-1565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5800 SW 60TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-2330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-343-5249
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT39567
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------