Individual
JOHN ROBERT SANTIAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8202 EXCELSIOR DR, MADISON, WI 53717-1906
(608) 662-5090
Mailing address
657 S SEGOE RD APT 1, MADISON, WI 53711-1046
(608) 852-5017
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1092-046
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1092-046
STATE LICENSE NUMBER
WI
Enumeration date
05/08/2009
Last updated
05/08/2009
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