Provider Demographics
NPI:1457553687
Name:SALVATORE, ANTHONY P (PHD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:SALVATORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CHERRY HL
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9428
Mailing Address - Country:US
Mailing Address - Phone:505-589-9203
Mailing Address - Fax:
Practice Address - Street 1:202 CHERRY HL
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9428
Practice Address - Country:US
Practice Address - Phone:505-589-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14759OtherSTATE LICENSE TO PRACTICE