Healthcare Provider Details

I. General information

NPI: 1265010516
Provider Name (Legal Business Name): DAVID SANTIAGO HOPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 OLENTANGY RIVER RD
COLUMBUS OH
43212-3381
US

IV. Provider business mailing address

70 S CLEVELAND AVE
WESTERVILLE OH
43081-1397
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-6555
  • Fax:
Mailing address:
  • Phone: 614-890-6555
  • Fax: 614-523-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019132
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT019132
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: