Provider Demographics
NPI:1376128140
Name:SANTOS, SAMANTHA (AP, LAC, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:AP, LAC, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9378 SW 156TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1118
Mailing Address - Country:US
Mailing Address - Phone:786-208-0589
Mailing Address - Fax:
Practice Address - Street 1:9100 S DADELAND BLVD STE 1547
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7814
Practice Address - Country:US
Practice Address - Phone:786-208-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL39402255A2300X
FLAP4185171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer