Provider Demographics
NPI:1932343100
Name:SANTANA, AMY ADELE (LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ADELE
Last Name:SANTANA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 VINEYARD DR APT 201
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3327
Mailing Address - Country:US
Mailing Address - Phone:216-322-9583
Mailing Address - Fax:
Practice Address - Street 1:951 VINEYARD DR APT 201
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3327
Practice Address - Country:US
Practice Address - Phone:216-322-9583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15920225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist