MEDICARE: CARLOS ALBERTO SALINAS LPTA

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	225200000X	Physical Therapy Assistant	2306602660	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VAA101671	OTHER	VA	MEDICARE PTAN

General Provider Information

NPI Number	:	1205101524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS ALBERTO SALINAS LPTA

Provider Business Mailing Address
First Line	:	2777 JEFFERSON DAVIS HWY
Second Line	:	SUITE 109
City	:	STAFFORD
State	:	VA
Zip	:	22554-8323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2777 JEFFERSON DAVIS HWY
Second Line	:	SUITE 109
City	:	STAFFORD
State	:	VA
Zip	:	22554-8323
Country	:	US
Telephone Number	:	540-318-8615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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