Provider Demographics
NPI:1033584453
Name:BONILLA SALGADO, JAVIER O (RPT)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:O
Last Name:BONILLA SALGADO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210-11 CALLE 508
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-0000
Mailing Address - Country:US
Mailing Address - Phone:787-203-3486
Mailing Address - Fax:787-859-4307
Practice Address - Street 1:CARR 159, KM 13.4
Practice Address - Street 2:(ENTRADA URB. LOMA LINDA)
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-1144
Practice Address - Country:US
Practice Address - Phone:787-859-5755
Practice Address - Fax:787-859-4307
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist