Provider Demographics
NPI:1285608109
Name:SALVATORE, JOHN R (AT,C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:SALVATORE
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 OLD WAGON RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-9204
Mailing Address - Country:US
Mailing Address - Phone:719-540-0517
Mailing Address - Fax:719-540-0517
Practice Address - Street 1:900 JIMMY CAMP RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-4190
Practice Address - Country:US
Practice Address - Phone:719-382-1640
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer