Provider Demographics
NPI:1215251350
Name:SANTOS, RONALDO URBE (PT)
Entity type:Individual
Prefix:MR
First Name:RONALDO
Middle Name:URBE
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:URBE
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3670 106TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5426
Mailing Address - Country:US
Mailing Address - Phone:727-561-0493
Mailing Address - Fax:
Practice Address - Street 1:10000 BAY PINES BLVD.
Practice Address - Street 2:BAY PINES VA MEDICAL CENTER
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33504
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 0007129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist