Provider Demographics
NPI:1326318270
Name:SANTORO, DOREEN LEIGH (PTA)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:LEIGH
Last Name:SANTORO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17380 ALT A1A STE 305
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5860
Mailing Address - Country:US
Mailing Address - Phone:561-741-1661
Mailing Address - Fax:
Practice Address - Street 1:17380 ALT A1A
Practice Address - Street 2:SUITE 305
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5860
Practice Address - Country:US
Practice Address - Phone:561-741-1661
Practice Address - Fax:561-741-1663
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 18353225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant