Provider Demographics
NPI:1154515666
Name:SALAS, EARLEE ALFONSO (MS, PT)
Entity type:Individual
Prefix:MR
First Name:EARLEE
Middle Name:ALFONSO
Last Name:SALAS
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 1516
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33526-1516
Mailing Address - Country:US
Mailing Address - Phone:813-841-2599
Mailing Address - Fax:
Practice Address - Street 1:615 VONDERBURG DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5972
Practice Address - Country:US
Practice Address - Phone:813-654-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT3692OtherLICENSE NUMBER