Provider Demographics
NPI:1205516648
Name:SANTANA, JOSE L
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:SANTANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 IMPATIENS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-7393
Mailing Address - Country:US
Mailing Address - Phone:863-840-1819
Mailing Address - Fax:
Practice Address - Street 1:250 PALM COAST PKWY NE UNIT 209
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8289
Practice Address - Country:US
Practice Address - Phone:386-597-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist