Provider Demographics
NPI:1689706814
Name:SALINAS PHYSICAL THERAPY SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:SALINAS PHYSICAL THERAPY SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:714-695-1566
Mailing Address - Street 1:23655 VIA DEL RIO
Mailing Address - Street 2:SUITE C
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-2718
Mailing Address - Country:US
Mailing Address - Phone:714-695-1566
Mailing Address - Fax:714-695-1553
Practice Address - Street 1:23655 VIA DEL RIO
Practice Address - Street 2:SUITE C
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-2718
Practice Address - Country:US
Practice Address - Phone:714-695-1566
Practice Address - Fax:714-695-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14523261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17104OtherGROUP MEDICARE ID