Provider Demographics
NPI:1194898130
Name:SALAM, SOAD A (RPT BS PHYSICAL THER)
Entity type:Individual
Prefix:
First Name:SOAD
Middle Name:A
Last Name:SALAM
Suffix:
Gender:F
Credentials:RPT BS PHYSICAL THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31961 MONARCH CRST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5451
Mailing Address - Country:US
Mailing Address - Phone:714-308-6171
Mailing Address - Fax:949-234-9644
Practice Address - Street 1:5750 DOWNEY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1405
Practice Address - Country:US
Practice Address - Phone:562-633-3501
Practice Address - Fax:562-421-1444
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT8778Medicare ID - Type Unspecified