Provider Demographics
NPI:1275014524
Name:SALAZAR, SIPRIAN SIPI (PTA)
Entity Type:Individual
Prefix:
First Name:SIPRIAN
Middle Name:SIPI
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 1:500 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2924
Mailing Address - Country:US
Mailing Address - Phone:956-687-4559
Mailing Address - Fax:956-687-4554
Practice Address - Street 1:1210 E 8TH ST STE 1A
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-7120
Practice Address - Country:US
Practice Address - Phone:956-351-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2119836225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2119836OtherECPTOTE