Provider Demographics
NPI:1841647534
Name:SALAZAR, STACIE MICHELLE (MAT, ATC, LAT)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:MICHELLE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 S 1ST ST
Mailing Address - Street 2:#1026
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6762
Mailing Address - Country:US
Mailing Address - Phone:805-835-2927
Mailing Address - Fax:
Practice Address - Street 1:793 UNION CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CEDAR CREEK
Practice Address - State:TX
Practice Address - Zip Code:78612-3223
Practice Address - Country:US
Practice Address - Phone:805-835-2927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer