Provider Demographics
NPI:1699339861
Name:SANTOS CALIZ, MARIA VICTORIA (PTA, AT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:VICTORIA
Last Name:SANTOS CALIZ
Suffix:
Gender:F
Credentials:PTA, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 AVE CONSTANCIA
Mailing Address - Street 2:URB VILLA DEL CARMEN
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2233
Mailing Address - Country:US
Mailing Address - Phone:787-438-4369
Mailing Address - Fax:
Practice Address - Street 1:4465 AVE CONSTANCIA
Practice Address - Street 2:URB VILLA DEL CARMEN
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2233
Practice Address - Country:US
Practice Address - Phone:787-438-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2056225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant