Provider Demographics
NPI:1326003526
Name:SALLADE, JEFFERY RYAN (MSPT,OCS, SCS)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:RYAN
Last Name:SALLADE
Suffix:
Gender:M
Credentials:MSPT,OCS, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COLEMAN CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-3585
Mailing Address - Country:US
Mailing Address - Phone:508-259-5481
Mailing Address - Fax:
Practice Address - Street 1:3 COLEMAN CT
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-3585
Practice Address - Country:US
Practice Address - Phone:508-259-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA011608002251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports