Provider Demographics
NPI:1700038486
Name:ELIAS-SANTIAGO, NILMA ZULEIKA (PT)
Entity Type:Individual
Prefix:MRS
First Name:NILMA
Middle Name:ZULEIKA
Last Name:ELIAS-SANTIAGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 TRENTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5359
Mailing Address - Country:US
Mailing Address - Phone:407-624-7060
Mailing Address - Fax:
Practice Address - Street 1:587 E STATE ROAD 434 UNIT 1021
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5284
Practice Address - Country:US
Practice Address - Phone:321-972-3238
Practice Address - Fax:321-972-3590
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1362225100000X
FLPT24583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE424639817950OtherDRIVER'S INSURANCE