Provider Demographics
NPI:1235250986
Name:SANTIAGO, EDNA (PT)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3901
Mailing Address - Country:US
Mailing Address - Phone:610-304-5384
Mailing Address - Fax:610-489-8274
Practice Address - Street 1:597 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3901
Practice Address - Country:US
Practice Address - Phone:610-304-5384
Practice Address - Fax:610-489-8274
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT014078L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist