Provider Demographics
NPI:1700126075
Name:KISS SALAMANCA, MARIA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEXANDRA
Last Name:KISS SALAMANCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PARKVIEW DR
Mailing Address - Street 2:APT 106
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2978
Mailing Address - Country:US
Mailing Address - Phone:786-970-6973
Mailing Address - Fax:
Practice Address - Street 1:800 PARKVIEW DR
Practice Address - Street 2:APT 106
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2978
Practice Address - Country:US
Practice Address - Phone:786-970-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist