Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 40QA01160800 | NJ |
Y | 2251X0800X | Physical Therapist - Orthopedic | 40QA01160800 | NJ |
NPI | 1326003526 |
---|---|
Provider Name | Mr. Jeffery Ryan Sallade |
First Address | Southampton, NJ 08088-3585 |
Second Address | Southampton, NJ 08088-3585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 03/10/2011 |