Healthcare Provider Details

I. General information

NPI: 1821140930
Provider Name (Legal Business Name): SANTIAGO PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33311 SANTIAGO RD
ACTON CA
93510-1416
US

IV. Provider business mailing address

33311 SANTIAGO RD
ACTON CA
93510-1416
US

V. Phone/Fax

Practice location:
  • Phone: 661-269-4712
  • Fax: 661-269-4728
Mailing address:
  • Phone: 661-269-4712
  • Fax: 661-269-4728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number11517
License Number StateCA

VIII. Authorized Official

Name: MRS. PATRICIA L. JAKOBI-STOPPER
Title or Position: OWNER
Credential: P.T., O.C.S.
Phone: 661-269-4712