Provider Demographics
NPI:1821067125
Name:SALERNO, MICHAEL JAMES (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:SALERNO
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 1:9676 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-1271
Mailing Address - Country:US
Mailing Address - Phone:402-384-9449
Mailing Address - Fax:402-384-9449
Practice Address - Street 1:9676 MEADOW DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-1271
Practice Address - Country:US
Practice Address - Phone:402-384-9449
Practice Address - Fax:402-384-9449
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01430225100000X
NE778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S39400Medicare UPIN
IAI16829Medicare ID - Type Unspecified
IAI16914Medicare ID - Type Unspecified