Provider Demographics
NPI:1083736771
Name:SALIBA, ETHAN NAJEEB (PT, ATC)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:NAJEEB
Last Name:SALIBA
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-7306
Mailing Address - Country:US
Mailing Address - Phone:434-970-9757
Mailing Address - Fax:434-982-5470
Practice Address - Street 1:UNIVERSITY OF VIRGINIA ATHLETICS
Practice Address - Street 2:290 MASSIE ROAD
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22904-2290
Practice Address - Country:US
Practice Address - Phone:434-982-5451
Practice Address - Fax:434-982-5470
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002380225100000X
MOR0345225100000X
VA01260004432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer