Individual
JESSE SALAZAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
315 W 3RD PL, ELOY, AZ 85131-2312
(520) 582-5396
Mailing address
315 W 3RD PL, ELOY, AZ 85131-2312
(520) 582-5396
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
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