Provider Demographics
NPI:1134275118
Name:SALGE, JAN (PT, LMT)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:SALGE
Suffix:
Gender:M
Credentials:PT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 BOUGAINVILLEA DR STE C
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2402
Mailing Address - Country:US
Mailing Address - Phone:321-633-9718
Mailing Address - Fax:321-633-9908
Practice Address - Street 1:197 BOUGAINVILLEA DR STE C
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2402
Practice Address - Country:US
Practice Address - Phone:321-633-9718
Practice Address - Fax:321-633-9908
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891696900Medicaid
FLY5188AMedicare ID - Type Unspecified