MEDICARE: MRS. MARIA RIZZA MARIAZETA SANTIAGO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070016705	IL

General Provider Information

NPI Number	:	1235440066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA RIZZA MARIAZETA SANTIAGO PT

Provider Business Mailing Address
First Line	:	1535 LAKE COOK RD STE 306
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1452
Country	:	US
Telephone Number	:	224-522-6550
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 LAKE COOK RD STE 306
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1452
Country	:	US
Telephone Number	:	224-522-6550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	02/12/2020

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