Provider Demographics
NPI:1598269086
Name:ROBLES-SORIANO, SALVADOR (AT, ATC)
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:ROBLES-SORIANO
Suffix:
Gender:M
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BUTTERNUT DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1517
Mailing Address - Country:US
Mailing Address - Phone:616-990-5344
Mailing Address - Fax:
Practice Address - Street 1:2107 N 26TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-9217
Practice Address - Country:US
Practice Address - Phone:616-990-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010019572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer