MEDICARE: ARIEL SANTOSA

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	2251P0200X	Pediatric Physical Therapist	PTL.0017184	CO

General Provider Information

NPI Number	:	1255089819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL SANTOSA

Provider Business Mailing Address
First Line	:	3623 LIPAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3046
Country	:	US
Telephone Number	:	216-956-0655
Fax Number	:

Provider Business Practice Location Address
First Line	:	3623 LIPAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3046
Country	:	US
Telephone Number	:	216-956-0655
Fax Number	:

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

Provider Enumeration Date	:	03/14/2022
Last Update Date	:	03/14/2022

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Directions to “ ARIEL SANTOSA ” Practice Location

Language	Start Address	Practice Location

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