Provider Demographics
NPI:1083191647
Name:SALAZAR, YUDEL GARZA (PTA)
Entity Type:Individual
Prefix:MR
First Name:YUDEL
Middle Name:GARZA
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 TOUCAN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0437
Mailing Address - Country:US
Mailing Address - Phone:956-358-3405
Mailing Address - Fax:
Practice Address - Street 1:7600 W INTERSTATE HIGHWAY 2 STE 4&5
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2063
Practice Address - Country:US
Practice Address - Phone:956-581-7171
Practice Address - Fax:956-581-7178
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2104029225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant