Basic Information
| Provider Information | |||||||||
| NPI: | 1578694667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTAELLA | ||||||||
| FirstName: | ROXANA | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT, DPT, C/NDT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4888 LOOP CENTRAL DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770812227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138389050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4888 LOOP CENTRAL DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176048907 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 1172067 | TX | N | Other Service Providers | Specialist | 222Q00000X | 30054 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 225100000X | 1172067 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 017055200 | 05 | FL | MEDICAID | 143404501 | 05 | TX | MEDICAID | 742965954 | 01 | TX | FACILITY TAX ID NO. | OTHER | 1629189246 | 01 | TX | NPI # | OTHER |