MEDICARE: ALEXIS SALUTA PT

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	225100000X	Physical Therapist	20002	CA

General Provider Information

NPI Number	:	1275963266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS SALUTA PT

Provider Business Mailing Address
First Line	:	1244 BODEGA BAY DR
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-2113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1244 BODEGA BAY DR
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-2113
Country	:	US
Telephone Number	:	619-977-7785
Fax Number	:

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

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	11/13/2013

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