MEDICARE: MINOR AUGUSTO SANTAMARIA ALFARO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	LPT-033595	AZ

General Provider Information

NPI Number	:	1215777081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINOR AUGUSTO SANTAMARIA ALFARO PT

Provider Business Mailing Address
First Line	:	712 W VIRGINIA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-1119
Country	:	US
Telephone Number	:	480-865-9646
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 W VIRGINIA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-1119
Country	:	US
Telephone Number	:	480-865-9646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	11/21/2024

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