MEDICARE: ERIC DAVID SANTIAGO

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	1190830	TX

General Provider Information

NPI Number	:	1689995508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC DAVID SANTIAGO

Provider Business Mailing Address
First Line	:	1117 CLEAR LAKE CITY BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-8102
Country	:	US
Telephone Number	:	832-224-4735
Fax Number	:	832-224-4679

Provider Business Practice Location Address
First Line	:	1117 CLEAR LAKE CITY BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-8102
Country	:	US
Telephone Number	:	832-224-4735
Fax Number	:	832-224-4679

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

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	08/08/2016

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Directions to “ ERIC DAVID SANTIAGO ” Practice Location

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