Provider Demographics
NPI:1447920087
Name:RIOS SANTIAGO, MARIMAR (DPT)
Entity type:Individual
Prefix:
First Name:MARIMAR
Middle Name:
Last Name:RIOS SANTIAGO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N ORLANDO AVE APT 417
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4609
Mailing Address - Country:US
Mailing Address - Phone:407-913-0185
Mailing Address - Fax:
Practice Address - Street 1:1053 MEDICAL CENTER DR STE 151
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8261
Practice Address - Country:US
Practice Address - Phone:386-917-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT376042251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology