Provider Demographics
NPI:1639219603
Name:SANTIAGO, ENNA D (PT)
Entity Type:Individual
Prefix:MRS
First Name:ENNA
Middle Name:D
Last Name: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:HC 2 BOX 13187
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-9688
Mailing Address - Country:US
Mailing Address - Phone:787-460-4632
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:JOSE I SANCHEZ ST
Practice Address - Street 2:2
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703
Practice Address - Country:US
Practice Address - Phone:787-460-4632
Practice Address - Fax:787-732-7512
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081374Medicare ID - Type UnspecifiedPROVIDER NUMBER