Healthcare Provider Details

I. General information

NPI: 1316873151
Provider Name (Legal Business Name): PATRICK DENIESE PAYABAN SANTOS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4546 163RD ST # 2F
FLUSHING NY
11358-3223
US

IV. Provider business mailing address

4546 163RD ST # 2F
FLUSHING NY
11358-3223
US

V. Phone/Fax

Practice location:
  • Phone: 224-829-5813
  • Fax: 224-829-5813
Mailing address:
  • Phone: 224-829-5813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055667
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: