Provider Demographics
NPI:1770123309
Name:TAN, SALVADOR RUIZ JR (PT)
Entity type:Individual
Prefix:MR
First Name:SALVADOR
Middle Name:RUIZ
Last Name:TAN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 67TH ST APT C4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4930
Mailing Address - Country:US
Mailing Address - Phone:347-554-4018
Mailing Address - Fax:
Practice Address - Street 1:6022 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4105
Practice Address - Country:US
Practice Address - Phone:347-784-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist