Provider Demographics
NPI:1609901800
Name:VILLAMIL, SANTIAGO (MPT)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:VILLAMIL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10908 MINDANAO DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-9552
Mailing Address - Country:US
Mailing Address - Phone:352-256-3324
Mailing Address - Fax:
Practice Address - Street 1:10908 MINDANAO DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9552
Practice Address - Country:US
Practice Address - Phone:352-256-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic