Provider Demographics
NPI:1639219124
Name:ALVARADO SANTIAGO, WENDELINE (PT)
Entity Type:Individual
Prefix:MISS
First Name:WENDELINE
Middle Name:
Last Name:ALVARADO SANTIAGO
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:URB. LAS DELICIAS
Mailing Address - Street 2:#1532 STGO. OPPENHEIMER
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-3900
Mailing Address - Country:US
Mailing Address - Phone:939-642-0799
Mailing Address - Fax:787-844-5361
Practice Address - Street 1:URB. LAS DELICIAS
Practice Address - Street 2:#1532 STGO. OPPENHEIMER
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-3900
Practice Address - Country:US
Practice Address - Phone:939-462-0799
Practice Address - Fax:787-844-5361
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1144OtherLICENCIA
PR1144OtherLICENCIA