Provider Demographics
NPI:1679793533
Name:SANTOS, CLARA M (PT)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:M
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:PO BOX 7798
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7798
Mailing Address - Country:US
Mailing Address - Phone:787-473-5955
Mailing Address - Fax:787-653-4003
Practice Address - Street 1:201 CALLE GAUTIER BENITEZ
Practice Address - Street 2:CONSOLIDATED MALL SUITE C-21
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5527
Practice Address - Country:US
Practice Address - Phone:787-653-4001
Practice Address - Fax:787-653-4003
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR915225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDC0608-099OtherPLAN REFORMA DE SALUD