Provider Demographics
NPI:1245252154
Name:SANTISO, AARON RICHARD (MPT, PES, CLT)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:RICHARD
Last Name:SANTISO
Suffix:
Gender:M
Credentials:MPT, PES, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1062
Mailing Address - Country:US
Mailing Address - Phone:954-533-5543
Mailing Address - Fax:754-223-2596
Practice Address - Street 1:3000 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1772
Practice Address - Country:US
Practice Address - Phone:954-533-5543
Practice Address - Fax:754-223-2596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4917ZMedicare ID - Type Unspecified