Provider Demographics
NPI:1740555135
Name:SALAMIDA, MARK DAVID (LMT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:SALAMIDA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 HOFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2157
Mailing Address - Country:US
Mailing Address - Phone:315-704-0319
Mailing Address - Fax:315-704-0160
Practice Address - Street 1:1 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2157
Practice Address - Country:US
Practice Address - Phone:315-704-0319
Practice Address - Fax:315-704-0160
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016985-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist