Provider Demographics
NPI:1740910983
Name:SALAZAR, KRISTINA IRENE (DPT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:IRENE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9426
Mailing Address - Country:US
Mailing Address - Phone:360-384-5111
Mailing Address - Fax:
Practice Address - Street 1:1887 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9426
Practice Address - Country:US
Practice Address - Phone:360-384-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61261107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist