Provider Demographics
NPI:1750467056
Name:SANTOS, TEENA MARIE
Entity Type:Individual
Prefix:MRS
First Name:TEENA MARIE
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 PLAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3201
Mailing Address - Country:US
Mailing Address - Phone:630-226-5449
Mailing Address - Fax:630-226-5449
Practice Address - Street 1:366 PLAINVIEW DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3201
Practice Address - Country:US
Practice Address - Phone:630-226-5449
Practice Address - Fax:630-226-5449
Is Sole Proprietor?:No
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist