MEDICARE: RAQUEL SANTIAGO R.P.T.

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	550	PR

General Provider Information

NPI Number	:	1811963523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL SANTIAGO R.P.T.

Provider Business Mailing Address
First Line	:	PO BOX 10000
Second Line	:	PMB 106
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0011
Country	:	US
Telephone Number	:	787-886-1311
Fax Number	:	787-886-1311

Provider Business Practice Location Address
First Line	:	63 CALLE HERNAIZ
Second Line	:	EZQUINA BATANCES
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0000
Country	:	US
Telephone Number	:	787-886-1311
Fax Number	:	787-886-1311

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/08/2007

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