Provider Demographics
NPI:1871796144
Name:SANTIAGO, HOLLY (PT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 VAN CORTLANDT PARK AVE
Mailing Address - Street 2:APT 2C
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3368
Mailing Address - Country:US
Mailing Address - Phone:201-218-8391
Mailing Address - Fax:866-903-4166
Practice Address - Street 1:498 VAN CORTLANDT PARK AVE
Practice Address - Street 2:APT 2C
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3368
Practice Address - Country:US
Practice Address - Phone:201-218-8391
Practice Address - Fax:866-903-4166
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028259-1OtherLICENSE
NY028259-1OtherLICENSE