Provider Demographics
NPI:1528343944
Name:SANTILLO, DOUGLAS RICHARD (DPHYT)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RICHARD
Last Name:SANTILLO
Suffix:
Gender:M
Credentials:DPHYT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:BOX 357051
Mailing Address - Street 2:CMDR NAVAL AF, FORCE HLTH SRVCS N01H NASNI
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92135-7051
Mailing Address - Country:US
Mailing Address - Phone:619-545-1148
Mailing Address - Fax:619-767-7417
Practice Address - Street 1:N01H FORCE HEALTH SERVICES
Practice Address - Street 2:NASNI
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92135-7051
Practice Address - Country:US
Practice Address - Phone:619-545-1148
Practice Address - Fax:619-767-7417
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-11462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist