Provider Demographics
NPI:1003521774
Name:SANTOS, REBECA (CLT)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 OAK RIDGE CT STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9370
Mailing Address - Country:US
Mailing Address - Phone:239-223-3586
Mailing Address - Fax:
Practice Address - Street 1:2739 OAK RIDGE CT STE 202
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9370
Practice Address - Country:US
Practice Address - Phone:239-223-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM42005225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist