Provider Demographics
NPI:1871794461
Name:SALAMANCAS THERAPY, P.C.
Entity type:Organization
Organization Name:SALAMANCAS THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST REGISTERED
Authorized Official - Prefix:
Authorized Official - First Name:SELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMANCA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:956-580-7579
Mailing Address - Street 1:1022 E GRIFFIN PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2400
Mailing Address - Country:US
Mailing Address - Phone:956-580-7579
Mailing Address - Fax:956-580-7987
Practice Address - Street 1:1022 E GRIFFIN PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2400
Practice Address - Country:US
Practice Address - Phone:956-580-7579
Practice Address - Fax:956-580-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105894261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX653024OtherBLUE CROSS BLUE SHIELD TX
TX089424801Medicaid
TX089424803Medicaid
TX089424801Medicaid