Provider Demographics
NPI:1073382057
Name:SALUD, MARK DANNIEL JAVIER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARK DANNIEL
Middle Name:JAVIER
Last Name:SALUD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 BARCELONA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-2226
Mailing Address - Country:US
Mailing Address - Phone:561-407-2093
Mailing Address - Fax:
Practice Address - Street 1:2338 BARCELONA AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-2226
Practice Address - Country:US
Practice Address - Phone:561-407-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist