Provider Demographics
NPI:1669817417
Name:SALVADOR, JOSE I (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:I
Last Name:SALVADOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7022 BOARDWALK AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4174
Mailing Address - Country:US
Mailing Address - Phone:361-944-0567
Mailing Address - Fax:
Practice Address - Street 1:7022 BOARDWALK AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4174
Practice Address - Country:US
Practice Address - Phone:361-944-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1179737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist