Provider Demographics
NPI:1326286816
Name:SANTACROSS, ADAM MICHAEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MICHAEL
Last Name:SANTACROSS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:ADAM
Other - Middle Name:MICHAEL
Other - Last Name:SANTACROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:8455 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5066
Mailing Address - Country:US
Mailing Address - Phone:352-465-5880
Mailing Address - Fax:352-465-5889
Practice Address - Street 1:20726 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-6717
Practice Address - Country:US
Practice Address - Phone:352-465-5880
Practice Address - Fax:352-465-5889
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21567225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106898OtherMEDICARE ID