Provider Demographics
NPI:1194238444
Name:SANTIAGO, JACQUELINE A (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412307
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6177
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:801 POINDEXTER ST STE 219
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-2358
Practice Address - Country:US
Practice Address - Phone:757-548-0014
Practice Address - Fax:757-351-1930
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293957225100000X
VA2305212539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist