Provider Demographics
NPI:1629110507
Name:SALTER, MITCHELL ATMORE (ATC, PTA)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:ATMORE
Last Name:SALTER
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4000 CENTRAL FLORIDA BLVD
Mailing Address - Street 2:HPA II
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32816-2205
Mailing Address - Country:US
Mailing Address - Phone:407-808-4865
Mailing Address - Fax:407-823-6138
Practice Address - Street 1:4000 CENTRAL FLORIDA BLVD
Practice Address - Street 2:HPA II
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-2205
Practice Address - Country:US
Practice Address - Phone:407-823-5232
Practice Address - Fax:407-823-6138
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 19118225200000X
FLAL 14192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer