Provider Demographics
NPI:1790703080
Name:SALAS, LOUIS (MS, RPT)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:SALAS
Suffix:
Gender:M
Credentials:MS, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 CANNES DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3815
Mailing Address - Country:US
Mailing Address - Phone:321-437-3550
Mailing Address - Fax:407-935-9811
Practice Address - Street 1:908 CANNES DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3815
Practice Address - Country:US
Practice Address - Phone:321-437-3550
Practice Address - Fax:407-935-9811
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5864YMedicare ID - Type UnspecifiedPROVIDER NUMBER