Basic Information
Provider Information
NPI: 1073010039
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SALINAS
FirstName: DAVID
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3901 UNIVERSITY BLVD S
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322164312
CountryCode: US
TelephoneNumber: 9043457336
FaxNumber:  
Practice Location
Address1: 1675 EAGLE HARBOR PKWY STE D
Address2:  
City: FLEMING ISLAND
State: FL
PostalCode: 320034802
CountryCode: US
TelephoneNumber: 9046370148
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/06/2018
LastUpdateDate: 04/06/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X33352FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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