Provider Demographics
NPI:1841209301
Name:SALAZAR, SANDRA JEAN (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:SALAZAR
Suffix:
Gender:F
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:PO BOX 30216
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85046-0216
Mailing Address - Country:US
Mailing Address - Phone:602-404-8012
Mailing Address - Fax:602-404-7195
Practice Address - Street 1:5410 E HIGH ST STE 107
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5457
Practice Address - Country:US
Practice Address - Phone:602-404-8012
Practice Address - Fax:602-404-7195
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ635021Medicaid
AZZ115442Medicare PIN