Provider Demographics
NPI:1750937553
Name:SALAS, DAVID FRANK JR (PT DPT CSCS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:FRANK
Last Name:SALAS
Suffix:JR
Gender:M
Credentials:PT DPT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-5469
Mailing Address - Country:US
Mailing Address - Phone:909-528-7674
Mailing Address - Fax:
Practice Address - Street 1:13313 PALM DR STE B
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-5980
Practice Address - Country:US
Practice Address - Phone:760-671-4760
Practice Address - Fax:760-671-4798
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist