Provider Demographics
NPI:1043343668
Name:SANTOS, MARYORY (PTA)
Entity Type:Individual
Prefix:
First Name:MARYORY
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20025 NW 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6614
Mailing Address - Country:US
Mailing Address - Phone:305-829-4935
Mailing Address - Fax:
Practice Address - Street 1:13903 NW 67TH AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2900
Practice Address - Country:US
Practice Address - Phone:305-512-5757
Practice Address - Fax:305-512-5755
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 19013225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant