Provider Demographics
NPI:1376875567
Name:J.A.SANTIAGO, MS, RPT, P.A.
Entity Type:Organization
Organization Name:J.A.SANTIAGO, MS, RPT, P.A.
Other - Org Name:PHYSICAL THERAPY WALK-IN/SANTIAGO THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RPT, PA
Authorized Official - Phone:813-876-7400
Mailing Address - Street 1:1720 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6508
Mailing Address - Country:US
Mailing Address - Phone:813-876-7400
Mailing Address - Fax:813-877-8145
Practice Address - Street 1:1720 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6508
Practice Address - Country:US
Practice Address - Phone:813-876-7400
Practice Address - Fax:813-877-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0700X, 261QX0100X
FLPT4581261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT4581OtherLICENSE