Provider Demographics
NPI:1467046474
Name:SANTIAGO, VALERIE LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYNN
Last Name:SANTIAGO
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 1:8165 S MINGO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4667
Mailing Address - Country:US
Mailing Address - Phone:918-615-6280
Mailing Address - Fax:918-615-6240
Practice Address - Street 1:8165 S MINGO RD STE 101
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4667
Practice Address - Country:US
Practice Address - Phone:918-615-6280
Practice Address - Fax:918-615-6240
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3268208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation