Healthcare Provider Details

I. General information

NPI: 1295611069
Provider Name (Legal Business Name): MARIANNE SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 DIXIE HWY
CHICAGO HEIGHTS IL
60411-2690
US

IV. Provider business mailing address

18221 CORK RD
TINLEY PARK IL
60477-4709
US

V. Phone/Fax

Practice location:
  • Phone: 708-754-5700
  • Fax:
Mailing address:
  • Phone: 708-263-7786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070.015004
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070015004
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015004
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: