Provider Demographics
NPI:1932544640
Name:SALVAT, MIGUEL A (PTA)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:SALVAT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:MIGUEL
Other - Middle Name:A
Other - Last Name:SALVAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6420 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5114
Mailing Address - Country:US
Mailing Address - Phone:786-452-1265
Mailing Address - Fax:786-452-1298
Practice Address - Street 1:2604 W 84TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5703
Practice Address - Country:US
Practice Address - Phone:786-452-1265
Practice Address - Fax:786-452-1298
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 23607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist