Basic Information
| Provider Information | |||||||||
| NPI: | 1417238635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALAS | ||||||||
| FirstName: | EDUARDO | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1565 SAXON BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | DELTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327255836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3868510901 | ||||||||
| FaxNumber: | 3868512426 | ||||||||
| Practice Location | |||||||||
| Address1: | 1565 SAXON BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | DELTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327255836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3868510901 | ||||||||
| FaxNumber: | 3868512426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2011 | ||||||||
| LastUpdateDate: | 09/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 21778 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.