Provider Demographics
NPI:1972881548
Name:AGUDO, SALIXTO AGUILAR JR (PT)
Entity type:Individual
Prefix:
First Name:SALIXTO
Middle Name:AGUILAR
Last Name:AGUDO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:CLINT
Other - Middle Name:AGUILAR
Other - Last Name:AGUDO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:236 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9306
Mailing Address - Country:US
Mailing Address - Phone:630-470-2561
Mailing Address - Fax:
Practice Address - Street 1:601 SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1167
Practice Address - Country:US
Practice Address - Phone:219-322-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015817225100000X
IN05013327A2251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty