Humberto Grimaldo-Salazar, PTA
Individual provider Active NPI Physical Therapy Assistant · Madill, OK
NPI 1265700256 · NPPES record last updated Dec 6, 2011
Key facts
- NPI
- 1265700256
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 1948 (OK)
- Practice address
- 105 N 5TH Ave
Madill, OK 73446-1200 - Phone
- (580) 795-3301
- Fax
- (580) 795-7307
- NPI assigned
- Dec 6, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1948 | OK | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 1948 | OK | Yes |
Addresses
Primary practice location
105 N 5TH Ave
Madill, OK 73446-1200
Mailing address
811 W Burney St
Madill, OK 73446-2642
Phone (580) 263-8484
Other providers in Madill, OK
- Shannon Beth Goodwin Chambers
- Ely R Gordon
- Johnny Duane Green
- Randall J Green
- Greg Clement Agency
- Susan Mathis Grogan
- Heidi Hardee
- Shawna Rose Hardison
- Her Hope Rising Inc
- Cleo Ellen Hightower
All providers in Madill, OK · Physical Therapy Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.