Provider Demographics
NPI:1588078810
Name:SALAZAR, MYRIEL ERMITA (PT)
Entity type:Individual
Prefix:MR
First Name:MYRIEL
Middle Name:ERMITA
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 1/2 FERNWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2108
Mailing Address - Country:US
Mailing Address - Phone:407-580-4121
Mailing Address - Fax:
Practice Address - Street 1:116 1/2 FERNWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2108
Practice Address - Country:US
Practice Address - Phone:407-580-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-14
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14797225100000X
MI5501014330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist