Provider Demographics
NPI:1235440066
Name:SANTIAGO, MARIA RIZZA MARIAZETA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA RIZZA
Middle Name:MARIAZETA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA RIZZA
Other - Middle Name:DYCHITAN
Other - Last Name:MARIAZETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1535 LAKE COOK RD STE 306
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1452
Mailing Address - Country:US
Mailing Address - Phone:224-522-6550
Mailing Address - Fax:
Practice Address - Street 1:1535 LAKE COOK RD STE 306
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1452
Practice Address - Country:US
Practice Address - Phone:224-522-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208325011Medicare PIN