Provider Demographics
NPI:1013087980
Name:SANTIAGO, JULIZA (RPT)
Entity Type:Individual
Prefix:
First Name:JULIZA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-27 197 STREET
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4036
Mailing Address - Country:US
Mailing Address - Phone:917-399-4986
Mailing Address - Fax:
Practice Address - Street 1:6727 197TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-4036
Practice Address - Country:US
Practice Address - Phone:917-399-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYQ08J41225100000X
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQO8J41Medicare ID - Type UnspecifiedNY PHYSICAL THERAPIST LIC