Provider Demographics
NPI:1821203738
Name:SALAS, KATHLEEN CANFORT (BS)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:CANFORT
Last Name:SALAS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:CANFORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 GREEN ST
Mailing Address - Street 2:#2
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5553
Mailing Address - Country:US
Mailing Address - Phone:978-744-7037
Mailing Address - Fax:978-741-8175
Practice Address - Street 1:275 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5404
Practice Address - Country:US
Practice Address - Phone:978-744-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist