Provider Demographics
NPI:1346860772
Name:VALENTINO, MOISES SANTIAGO (PT - DPT)
Entity type:Individual
Prefix:
First Name:MOISES
Middle Name:SANTIAGO
Last Name:VALENTINO
Suffix:
Gender:M
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 1:212 JASMINE CIR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-1794
Mailing Address - Country:US
Mailing Address - Phone:334-406-6629
Mailing Address - Fax:
Practice Address - Street 1:212 JASMINE CIR
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1794
Practice Address - Country:US
Practice Address - Phone:334-406-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist