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General NPI Number Information
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NPI Number | 1831679984
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Entity Type | Individual
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Provider Name | JESSE SALAZAR PTA
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Gender | Male
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 315 W 3RD PL
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City | ELOY
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State | AZ
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Zip | 85131-2312
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Country | US
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Telephone | 520-582-5396
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Fax |
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Provider Business Mailing Address
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Address Line | 315 W 3RD PL
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City | ELOY
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State | AZ
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Zip | 85131-2312
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Country | US
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Telephone | 520-582-5396
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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License Number | 11854A
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License Number State | AZ
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