Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | TE1001863 | PA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC008926 | PA |
NPI | 1225353360 |
---|---|
Provider Name | Mrs. Kezia Darlene Santo |
First Address | Parkton, MD 21120-9677 |
Second Address | York, PA 17402-3542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2010 |
Last Update Date | 01/04/2010 |