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General NPI Number Information
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NPI Number | 1205438546
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Entity Type | Individual
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Provider Name | JOHNATHAN A SALINAS LMT, PTA
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Gender | Male
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 3816 PEMBROOK DR
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City | ORLANDO
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State | FL
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Zip | 32810-2336
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Country | US
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Telephone | 321-279-8682
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Fax |
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Provider Business Mailing Address
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Address Line | 3816 PEMBROOK DR
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City | ORLANDO
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State | FL
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Zip | 32810-2336
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Country | US
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Telephone | 321-279-8682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA30066
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA76197
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License Number State | FL
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