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NPI Code Detail

MEDICARE: WENDY JEANNE SANTIAGO PTA

MEDICARE: WENDY JEANNE SANTIAGO PTA
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
1225200000XPhysical Therapy AssistantPTA 19171FL

General Provider Information

NPI Number : 1528183647
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY JEANNE SANTIAGO PTA
Provider Business Mailing Address
First Line : 1917 EMILY BLVD
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33884-0003
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 625 OVERLOOK DR
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33884-1626
Country : US
Telephone Number : 863-318-1315
Fax Number : 863-326-9432
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 09/07/2023

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