Provider Demographics
NPI:1356325542
Name:SALLEY, ERIK RICHARD (PT DPT MA OCS CMDT)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:RICHARD
Last Name:SALLEY
Suffix:
Gender:M
Credentials:PT DPT MA OCS CMDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 MADISON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3785
Mailing Address - Country:US
Mailing Address - Phone:951-329-3928
Mailing Address - Fax:951-374-0621
Practice Address - Street 1:3505 MADISON ST STE 102
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3785
Practice Address - Country:US
Practice Address - Phone:951-329-3928
Practice Address - Fax:951-374-0621
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226692251X0800X
CAPT22669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0175125OtherWA DEPT OF LABOR
650024812OtherRAILROAD MEDICARE
650024812OtherRAILROAD MEDICARE