Provider Demographics
NPI:1396927349
Name:SANTOS, TONI M (RPT)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:M
Last Name:SANTOS
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 1:480 WORTHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-5042
Mailing Address - Country:US
Mailing Address - Phone:239-389-4960
Mailing Address - Fax:
Practice Address - Street 1:583 TALLWOOD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2887
Practice Address - Country:US
Practice Address - Phone:239-389-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-02
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1623AMedicare UPIN