Provider Demographics
NPI:1710353099
Name:SALAMAT, JEROME ESTRADA (PT)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:ESTRADA
Last Name:SALAMAT
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 1:8526 W MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-6706
Mailing Address - Country:US
Mailing Address - Phone:443-808-5511
Mailing Address - Fax:
Practice Address - Street 1:1300 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-1436
Practice Address - Country:US
Practice Address - Phone:928-425-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25638225100000X
AZLPT-013328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist