Provider Demographics
NPI:1740709997
Name:CASANOVA, SANTIAGO (PT)
Entity type:Individual
Prefix:MR
First Name:SANTIAGO
Middle Name:
Last Name:CASANOVA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 E MOLER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1127
Mailing Address - Country:US
Mailing Address - Phone:614-779-3646
Mailing Address - Fax:
Practice Address - Street 1:5130 BRADENTON AVE STE B
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7068
Practice Address - Country:US
Practice Address - Phone:614-336-8733
Practice Address - Fax:614-336-0658
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH016807OtherOTPTAT