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1265384408 NPI number — EDILBERTO JOSEF SANTIAGO JR. PT

NPI Number: 1265384408
Health Care Provider/Practitioner: EDILBERTO JOSEF SANTIAGO JR. PT

Information about “1265384408” NPI (EDILBERTO JOSEF SANTIAGO JR. PT) exists in 1265384408 in HTML format HTML  |  1265384408 in plain Text format TXT  |  1265384408 in PDF (Portable Document Format) PDF  |  1265384408 in an XML format XML  formats.

NPI Number : 1265384408 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265384408",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SANTIAGO",
    "FirstName": "EDILBERTO",
    "MiddleName": "JOSEF",
    "NamePrefix": null,
    "NameSuffix": "JR.",
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5645 16TH AVE N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT PETERSBURG",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33710-5720",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "941-718-3476",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4600 54TH AVE S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT PETERSBURG",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33711-4664",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "727-288-9123",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/11/2026",
    "LastUpdateDate": "02/11/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "PT27106",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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