Provider Demographics
NPI:1821140930
Name:SANTIAGO PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SANTIAGO PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAKOBI-STOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:661-269-4712
Mailing Address - Street 1:33311 SANTIAGO RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-1416
Mailing Address - Country:US
Mailing Address - Phone:661-269-4712
Mailing Address - Fax:661-269-4728
Practice Address - Street 1:33311 SANTIAGO RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-1416
Practice Address - Country:US
Practice Address - Phone:661-269-4712
Practice Address - Fax:661-269-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11517261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT11517AMedicare PIN