Provider Demographics
NPI:1124191168
Name:SALAM, ADEL A (RPT BS PHYSICAL THER)
Entity type:Individual
Prefix:
First Name:ADEL
Middle Name:A
Last Name:SALAM
Suffix:
Gender:M
Credentials:RPT BS PHYSICAL THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 DOWNEY AVE
Mailing Address - Street 2:#301
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712
Mailing Address - Country:US
Mailing Address - Phone:562-633-3501
Mailing Address - Fax:562-633-6178
Practice Address - Street 1:5750 DOWNEY AVE
Practice Address - Street 2:#301
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:562-633-3501
Practice Address - Fax:562-633-6178
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT8627Medicare ID - Type Unspecified