Provider Demographics
NPI:1578027579
Name:SANTOS, GEENAH MAY ENCARNADO (PT)
Entity Type:Individual
Prefix:
First Name:GEENAH MAY
Middle Name:ENCARNADO
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 AVENUE B APT 141
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1335
Mailing Address - Country:US
Mailing Address - Phone:915-206-0895
Mailing Address - Fax:
Practice Address - Street 1:8501 LAURENS LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-6092
Practice Address - Country:US
Practice Address - Phone:210-804-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001206079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty