Provider Demographics
NPI:1336381227
Name:SALAS, JEANENE SUSAN (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:JEANENE
Middle Name:SUSAN
Last Name:SALAS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2511
Mailing Address - Country:US
Mailing Address - Phone:386-734-4334
Mailing Address - Fax:386-736-2118
Practice Address - Street 1:1200 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2511
Practice Address - Country:US
Practice Address - Phone:386-734-4334
Practice Address - Fax:386-736-2118
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist