Provider Demographics
NPI:1730239765
Name:SANTOS, TANIA MD (PT)
Entity type:Individual
Prefix:MS
First Name:TANIA
Middle Name:MD
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:216 MUNSON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3099
Mailing Address - Country:US
Mailing Address - Phone:231-947-3144
Mailing Address - Fax:231-947-0415
Practice Address - Street 1:216 MUNSON AVE STE B
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3099
Practice Address - Country:US
Practice Address - Phone:231-947-3144
Practice Address - Fax:231-947-0415
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00323043OtherRR MEDICARE
MIP00323043OtherRR MEDICARE