Provider Demographics
NPI:1518003326
Name:DESANTIS, ROBERT SAMUEL (ATC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SAMUEL
Last Name:DESANTIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 67TH AVENUE CIR E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5101
Mailing Address - Country:US
Mailing Address - Phone:941-993-9606
Mailing Address - Fax:
Practice Address - Street 1:4258 67TH AVENUE CIR E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-5101
Practice Address - Country:US
Practice Address - Phone:941-993-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL-1309390200000X
FLAL13092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program