Individual
MR. IVAN R SALAZAR
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
BARRON DR, INSTITUTE, WV 25112-1004
(304) 766-4869
(304) 766-4867
Mailing address
PO BOX 1004, BARRON DR, INSTITUTE, WV 25112-1004
(304) 766-4869
(304) 766-4867
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
000674
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001722910
MTN ST BC/BS PROVIDER
WV
01
—
000674
WV BD OF PT
WV
05
—
0157318000
—
WV
Enumeration date
01/09/2006
Last updated
07/09/2007
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