Provider Demographics
NPI:1083969117
Name:DISALVO, DAVID (DPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:DISALVO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1056
Mailing Address - Country:US
Mailing Address - Phone:315-769-4200
Mailing Address - Fax:
Practice Address - Street 1:MH OUTPATIENT CTR/PHYSICAL THERAPY
Practice Address - Street 2:271 ANDREWS ST, SUITE 269
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662
Practice Address - Country:US
Practice Address - Phone:315-769-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-15
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist