=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023395365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANTISO PT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2011
-----------------------------------------------------
Last Update Date | 06/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N FEDERAL HWY APT 915
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33301-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-288-7480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 N FEDERAL HWY APT 915
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33301-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-288-7480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT/CEO
-----------------------------------------------------
Name | AARON SANTISO
-----------------------------------------------------
Credential | MPT, PES
-----------------------------------------------------
Telephone | 954-288-7480
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 21532
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------