Provider Demographics
NPI:1376342592
Name:SALOMONE, DENISE DANIELLE (PTA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:DANIELLE
Last Name:SALOMONE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:DANIELLE
Other - Last Name:MALLORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1161 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-7144
Mailing Address - Country:US
Mailing Address - Phone:760-576-1105
Mailing Address - Fax:
Practice Address - Street 1:901 CALLE AMANECER STE 320
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-4222
Practice Address - Country:US
Practice Address - Phone:949-366-6785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53614225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant