Provider Demographics
NPI:1093147464
Name:SANTALUCIA, MARIA ELIZABETH
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELIZABETH
Last Name:SANTALUCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 BRAMBLETON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3410
Mailing Address - Country:US
Mailing Address - Phone:540-774-0729
Mailing Address - Fax:540-774-0862
Practice Address - Street 1:4633 BRAMBLETON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3410
Practice Address - Country:US
Practice Address - Phone:540-774-0729
Practice Address - Fax:540-774-0862
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist