Provider Demographics
NPI:1821735283
Name:SALA, ELIO ALEJANDRO (PTA)
Entity type:Individual
Prefix:
First Name:ELIO
Middle Name:ALEJANDRO
Last Name:SALA
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12691 SW 191ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3839
Mailing Address - Country:US
Mailing Address - Phone:786-226-5747
Mailing Address - Fax:
Practice Address - Street 1:12691 SW 191ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-3839
Practice Address - Country:US
Practice Address - Phone:786-226-5747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2025-04-16
Deactivation Date:2024-09-25
Deactivation Code:
Reactivation Date:2025-04-08
Provider Licenses
StateLicense IDTaxonomies
FLPTA26174225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant