MEDICARE: SALOSAA INTEGRATED LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1053025635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALOSAA INTEGRATED LLC

Provider Business Mailing Address
First Line	:	7509 N 35TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-7480
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7509 N 35TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-7480
Country	:	US
Telephone Number	:	480-468-1796
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA OWENS
Credential	:
Telephone Number	:	480-468-1796

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	02/10/2025

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Directions to “SALOSAA INTEGRATED LLC ” Practice Location

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