Provider Demographics
NPI:1437521135
Name:SANTOS, CLEITON (PTA)
Entity Type:Individual
Prefix:
First Name:CLEITON
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 SW 27TH AVE APT 410
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2081
Mailing Address - Country:US
Mailing Address - Phone:305-218-2852
Mailing Address - Fax:
Practice Address - Street 1:2020 NE 163RD ST STE 207
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4927
Practice Address - Country:US
Practice Address - Phone:305-949-6461
Practice Address - Fax:305-945-8054
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24677171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor