Provider Demographics
NPI:1235473398
Name:GARCIA-SALINAS, JESSICA MAE (LPTA, CEAS1)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MAE
Last Name:GARCIA-SALINAS
Suffix:
Gender:F
Credentials:LPTA, CEAS1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:VILLANUEVA
Mailing Address - State:NM
Mailing Address - Zip Code:87583-0032
Mailing Address - Country:US
Mailing Address - Phone:505-424-1239
Mailing Address - Fax:
Practice Address - Street 1:2538 CAMINO ENTRADA STE 300
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4927
Practice Address - Country:US
Practice Address - Phone:505-424-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-342225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant