Healthcare Provider Details

I. General information

NPI: 1205418688
Provider Name (Legal Business Name): VSANTAMARIA PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2021
Last Update Date: 04/25/2021
Certification Date: 04/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 QUEENS BLVD APT 19W
FOREST HILLS NY
11375-3657
US

IV. Provider business mailing address

10440 QUEENS BLVD APT 19W
FOREST HILLS NY
11375-3657
US

V. Phone/Fax

Practice location:
  • Phone: 541-974-8153
  • Fax:
Mailing address:
  • Phone: 541-974-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR FRANCISCO SANTAMARIA GONZALEZ
Title or Position: COMPANY PRESIDENT & PT PROVIDER
Credential: PT, MS, PHD
Phone: 541-974-8153