Provider Demographics
NPI:1245848720
Name:SANTUCCI, ELISHEBA ANN (LMT)
Entity type:Individual
Prefix:
First Name:ELISHEBA
Middle Name:ANN
Last Name:SANTUCCI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ELISHEBA
Other - Middle Name:ANN
Other - Last Name:MANTOVANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1421 KEMPSVILLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1406
Mailing Address - Country:US
Mailing Address - Phone:757-410-5322
Mailing Address - Fax:757-548-0670
Practice Address - Street 1:1421 KEMPSVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1406
Practice Address - Country:US
Practice Address - Phone:757-410-5322
Practice Address - Fax:757-548-0670
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist