Individual
JESSE SALAZAR
Active
Individual
JESSE SALAZAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
11854A
AZ
225200000X
Physical Therapy Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11854A
—
AZ
Enumeration date
08/17/2018
Last updated
08/17/2018
Update your record
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