Provider Demographics
NPI:1114471588
Name:SANTANA-TATARAC, LIZSANDRA K (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:LIZSANDRA
Middle Name:K
Last Name:SANTANA-TATARAC
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:LIZSANDRA
Other - Middle Name:
Other - Last Name:SANTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:925 HEMPSTEAD TPKE
Mailing Address - Street 2:#310
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:925 HEMPSTEAD TPKE
Practice Address - Street 2:#310
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3641
Practice Address - Country:US
Practice Address - Phone:516-354-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0016722255A2300X
NY040728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer