Provider Demographics
NPI:1205101524
Name:SALINAS, CARLOS ALBERTO (LPTA)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:SALINAS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2777 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8323
Practice Address - Country:US
Practice Address - Phone:540-318-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602660225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA101671OtherMEDICARE PTAN