Provider Demographics
NPI:1659732220
Name:SALAS, ROLANDO
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:SALAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WILLIAMS STREET
Mailing Address - Street 2:P.O. BOX 316
Mailing Address - City:STINNETT
Mailing Address - State:TX
Mailing Address - Zip Code:79083-7301
Mailing Address - Country:US
Mailing Address - Phone:806-231-7243
Mailing Address - Fax:
Practice Address - Street 1:600 STEWART STREET
Practice Address - Street 2:
Practice Address - City:STINNETT
Practice Address - State:TX
Practice Address - Zip Code:79083-7301
Practice Address - Country:US
Practice Address - Phone:806-878-2456
Practice Address - Fax:806-878-4242
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer