Provider Demographics
NPI:1669643219
Name:SANTIAGO, JOSE ANTONIO SR (MS, RPT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANTONIO
Last Name:SANTIAGO
Suffix:SR
Gender:M
Credentials:MS, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 W. DR. MARTIN LUTHER KING JR. BLVD.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-876-7400
Mailing Address - Fax:813-877-8145
Practice Address - Street 1:1720 W. DR. MARTIN LUTHER KING JR. BLVD.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-876-7400
Practice Address - Fax:813-877-8145
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010880000Medicaid
FLK1578AMedicare UPIN