Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT37604 | FL |
NPI | 1447920087 |
---|---|
Provider Name | Marimar Rios Santiago |
First Address | Maitland, FL 32751-4609 |
Second Address | Orange City, FL 32763-8261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2021 |
Last Update Date | 15/09/2021 |