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General NPI Number Information
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NPI Number | 1326849555
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Entity Type | Individual
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Provider Name | MATTHEW SALERNO PTA
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Gender | Male
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 3965 W 83RD ST STE 126
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5308
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Country | US
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Telephone | 913-945-1215
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Fax |
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Provider Business Mailing Address
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Address Line | 102 E BERTRAND AVE
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City | SAINT MARYS
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State | KS
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Zip | 66536-1644
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Country | US
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Telephone | 785-317-4244
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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 | 2081P0301X
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Taxonomy Name | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 14-03222
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License Number State | KS
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