Basic Information
Provider Information
NPI: 1558485144
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SALINAS
FirstName: MARNE
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8000 SR 64 E
Address2:  
City: BRADENTON
State: FL
PostalCode: 34212
CountryCode: US
TelephoneNumber: 9417921404
FaxNumber: 9417951717
Practice Location
Address1: 8000 SR 64 E
Address2:  
City: BRADENTON
State: FL
PostalCode: 34212
CountryCode: US
TelephoneNumber: 9417921404
FaxNumber: 9417951717
Other Information
ProviderEnumerationDate: 03/19/2007
LastUpdateDate: 05/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251S0007XPT21816FLN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
2251X0800XPT21816FLN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
225100000XPT21816FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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