Provider Demographics
NPI:1114634581
Name:SANTIAGO, SONJA T (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:T
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 1:131 N 2ND ST STE 222
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4405
Mailing Address - Country:US
Mailing Address - Phone:954-282-9684
Mailing Address - Fax:
Practice Address - Street 1:131 N 2ND ST STE 222
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4405
Practice Address - Country:US
Practice Address - Phone:954-282-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA88439225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA88439OtherMEDICAL MASSAGE AND BODYWORK LICENSE