Basic Information
| Provider Information | |||||||||
| NPI: | 1386000628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTIAGO | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 PINEHURST AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283877138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106909955 | ||||||||
| FaxNumber: | 9106848634 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 PINEHURST AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283877138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106909955 | ||||||||
| FaxNumber: | 9106848634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2015 | ||||||||
| LastUpdateDate: | 12/31/2015 | ||||||||
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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 | 225700000X | 1448 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.