Healthcare Provider Details

I. General information

NPI: 1891802336
Provider Name (Legal Business Name): MARIANA ORRICO SANTOS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NORTHWEST 12TH AVENUE
MIAMI FL
33136
US

IV. Provider business mailing address

723 CRANDON BOULEVARD #206
KEY BISCAYNE FL
33149
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6334
  • Fax:
Mailing address:
  • Phone: 305-606-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: