Jesse Salazar, PTA
Individual provider Active NPI Pediatric Rehabilitation Medicine Physician · Eloy, AZ
NPI 1831679984 · NPPES record last updated Aug 17, 2018
Key facts
- NPI
- 1831679984
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Rehabilitation Medicine Physician 2081P0010X
- License
- 11854A (AZ)
- Practice address
- 315 W 3Rd PL
Eloy, AZ 85131-2312 - Phone
- (520) 582-5396
- NPI assigned
- Aug 17, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 11854A | AZ | MD | Pediatric Rehabilitation Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | |||
| Pediatric Rehabilitation Medicine Physician | 2081P0010X | 11854A | AZ | Yes |
Addresses
Primary practice location
315 W 3Rd PL
Eloy, AZ 85131-2312
Mailing address
315 W 3Rd PL
Eloy, AZ 85131-2312
Phone (520) 582-5396
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11854A | Medicaid | AZ |
Other providers in Eloy, AZ
- Precious Dental Service PLC
- Precious Hands Healthcare
- Resiliency Integrated Healthcare Services
- Christie Therese Rogers
- Brian C Rosenau
- Joel Salazar Jr.
- Santa Cruz Valley Union High School
- Carina Jimenez Serrano
- Sun Life Family Health Center, Inc
- Sun Life Family Health Center, Inc.
All providers in Eloy, AZ · Pediatric Rehabilitation Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2018. 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.