Provider Demographics
NPI:1639479538
Name:SALAMA, NARDINE N (DPT)
Entity Type:Individual
Prefix:
First Name:NARDINE
Middle Name:N
Last Name:SALAMA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SCUDDERS LN
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:11547-3019
Mailing Address - Country:US
Mailing Address - Phone:551-221-1290
Mailing Address - Fax:
Practice Address - Street 1:108 SCUDDERS LN
Practice Address - Street 2:
Practice Address - City:GLENWOOD LANDING
Practice Address - State:NY
Practice Address - Zip Code:11547-3019
Practice Address - Country:US
Practice Address - Phone:551-221-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist