Provider Demographics
NPI:1528183647
Name:SANTIAGO, WENDY JEANNE (PTA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JEANNE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:JEANNE
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1917 EMILY BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-0003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-1626
Practice Address - Country:US
Practice Address - Phone:863-318-1315
Practice Address - Fax:863-326-9432
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 19171225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant