Provider Demographics
NPI:1093947830
Name:SANTIAGO, JACQUELINE (LMT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12780 WATERFORD LAKES PKWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4500
Mailing Address - Country:US
Mailing Address - Phone:407-207-7188
Mailing Address - Fax:407-207-7103
Practice Address - Street 1:12780 WATERFORD LAKES PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4500
Practice Address - Country:US
Practice Address - Phone:407-207-7188
Practice Address - Fax:407-207-7103
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51762225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist