Healthcare Provider Details

I. General information

NPI: 1003482399
Provider Name (Legal Business Name): BRIAN PATRICK SANTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date: 06/18/2026
Reactivation Date: 07/21/2026

III. Provider practice location address

3475 ERWIN RD
DURHAM NC
27705-0005
US

IV. Provider business mailing address

1800 JEFFERSON PARK AVE APT 61
CHARLOTTESVILLE VA
22903-3546
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-2445
  • Fax:
Mailing address:
  • Phone: 908-914-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP25015
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: