Basic Information
| Provider Information | |||||||||
| NPI: | 1326318270 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTORO | ||||||||
| FirstName: | DOREEN | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17380 ALT A1A STE 305 | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334775860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617411661 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17380 ALT A1A | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334775860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617411661 | ||||||||
| FaxNumber: | 5617411663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2012 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA 18353 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.