Healthcare Provider Details

I. General information

NPI: 1376176701
Provider Name (Legal Business Name): MARIA L COLLAZO-SANTIAGO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CALLE FLOR GERENA S
HUMACAO PR
00791-4207
US

IV. Provider business mailing address

21 CALLE CEREZO
LAS PIEDRAS PR
00771-9023
US

V. Phone/Fax

Practice location:
  • Phone: 787-285-0080
  • Fax: 787-285-0461
Mailing address:
  • Phone: 939-216-1924
  • Fax: 787-285-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number879
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: