MEDICARE: MR. ARIEL SALTO 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	2006032826	MO

General Provider Information

NPI Number	:	1467651174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARIEL SALTO PT

Provider Business Mailing Address
First Line	:	4603 RIDGEWOOD AVE
Second Line	:	APT 4
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-1427
Country	:	US
Telephone Number	:	636-284-9880
Fax Number	:

Provider Business Practice Location Address
First Line	:	4603 RIDGEWOOD AVE
Second Line	:	APARTMENT 4
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-1427
Country	:	US
Telephone Number	:	636-284-9880
Fax Number	:

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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