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General NPI Number Information
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NPI Number | 1144527722
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Entity Type | Individual
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Provider Name | GLENDA LEE SANTIAGO L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 10622 DEVCO DR
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City | PORT RICHEY
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State | FL
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Zip | 34668-2871
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Country | US
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Telephone | 727-233-2025
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Fax | 727-233-6294
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Provider Business Mailing Address
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Address Line | 1802 E ESKIMO AVE
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City | TAMPA
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State | FL
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Zip | 33604-2020
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Country | US
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Telephone | 813-378-1184
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Fax | 727-233-6294
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 61731
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License Number State | FL
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