MEDICARE: EDWIN GLORIA SALAZAR

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

General Provider Information

NPI Number	:	1538467428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN GLORIA SALAZAR

Provider Business Mailing Address
First Line	:	2129 25TH RD
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-3425
Country	:	US
Telephone Number	:	941-421-2061
Fax Number	:

Provider Business Practice Location Address
First Line	:	2129 25TH RD
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-3425
Country	:	US
Telephone Number	:	941-421-2061
Fax Number	:

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

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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Directions to “ EDWIN GLORIA SALAZAR ” Practice Location

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