Healthcare Provider Details

I. General information

NPI: 1215089651
Provider Name (Legal Business Name): PATRICIA SANTRY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 STILLWELLS CORNER RD
FREEHOLD NJ
07728
US

IV. Provider business mailing address

1 HILLSIDE TER
MORGANVILLE NJ
07751-1122
US

V. Phone/Fax

Practice location:
  • Phone: 732-308-0099
  • Fax: 732-308-0347
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00271700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: