Provider Demographics
NPI:1760657852
Name:SANTIAGO, GERARDO ADONIS (PT)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:ADONIS
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7726 US HWY 165
Mailing Address - Street 2:HAVEN REHABILITATION CENTER
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418
Mailing Address - Country:US
Mailing Address - Phone:318-649-9826
Mailing Address - Fax:318-649-9827
Practice Address - Street 1:7726 US HWY 165
Practice Address - Street 2:HAVEN REHABILITATION CENTER
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418
Practice Address - Country:US
Practice Address - Phone:318-649-9826
Practice Address - Fax:318-649-9827
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01144F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG7648OtherBLUE CROSS OF LOUISIANA