Provider Demographics
NPI:1144083080
Name:SALAZAR, TILLIE (PT)
Entity type:Individual
Prefix:
First Name:TILLIE
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TILLIE
Other - Middle Name:
Other - Last Name:HEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5001 W PAULINE WHITAKER PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-7341
Mailing Address - Country:US
Mailing Address - Phone:479-202-0337
Mailing Address - Fax:479-202-0338
Practice Address - Street 1:5001 W PAULINE WHITAKER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-7341
Practice Address - Country:US
Practice Address - Phone:479-202-0337
Practice Address - Fax:479-202-0338
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5430225100000X, 2251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports