Provider Demographics
NPI:1225384324
Name:SALAZAR, ARCHIE SISON (PT)
Entity Type:Individual
Prefix:
First Name:ARCHIE
Middle Name:SISON
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6523B SAYLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-5560
Mailing Address - Country:US
Mailing Address - Phone:704-438-8197
Mailing Address - Fax:
Practice Address - Street 1:6523B SAYLE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-5560
Practice Address - Country:US
Practice Address - Phone:704-438-8197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist