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General NPI Number Information
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NPI Number | 1740752591
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Entity Type | Individual
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Provider Name | MS. KATHLEEN BLACKMAN SALAMON
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Gender | Female
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 582 EAST HARDING AVENUE
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City | STOCKTON
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State | CA
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Zip | 95204-6110
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Country | US
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Telephone | 209-279-5617
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Fax | 209-718-7190
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Provider Business Mailing Address
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Address Line | 1844 ALLSTON WAY
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City | STOCKTON
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State | CA
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Zip | 95204-5202
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Country | US
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Telephone | 209-639-0997
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | PT5706
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License Number State | CA
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