Provider Demographics
NPI:1043021124
Name:SALOOM, EDELYN PREPOSE
Entity type:Individual
Prefix:
First Name:EDELYN
Middle Name:PREPOSE
Last Name:SALOOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 HARRISON DR
Mailing Address - Street 2:
Mailing Address - City:KERMIT
Mailing Address - State:TX
Mailing Address - Zip Code:79745-4904
Mailing Address - Country:US
Mailing Address - Phone:503-580-4713
Mailing Address - Fax:
Practice Address - Street 1:1510 E SEALY AVE
Practice Address - Street 2:
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4050
Practice Address - Country:US
Practice Address - Phone:503-580-4713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT136559225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist