Provider Demographics
NPI:1326097007
Name:SANTOS, JEFFREY ZAMORA (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ZAMORA
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24027 WALNUT CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2472
Mailing Address - Country:US
Mailing Address - Phone:815-254-7043
Mailing Address - Fax:
Practice Address - Street 1:24027 WALNUT CIR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-2472
Practice Address - Country:US
Practice Address - Phone:815-254-7043
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist