Basic Information
| Provider Information | |||||||||
| NPI: | 1710353099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALAMAT | ||||||||
| FirstName: | JEROME | ||||||||
| MiddleName: | ESTRADA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8526 W MYRTLE AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853056706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438085511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 E SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | GLOBE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855011436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284253118 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2015 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 25638 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | LPT-013328 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.