Provider Demographics
NPI:1437601473
Name:SANTIAGO, SONNY JR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SONNY
Middle Name:
Last Name:SANTIAGO
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4234
Mailing Address - Country:US
Mailing Address - Phone:808-935-5255
Mailing Address - Fax:
Practice Address - Street 1:740 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4234
Practice Address - Country:US
Practice Address - Phone:808-935-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist