Healthcare Provider Details

I. General information

NPI: 1922724848
Provider Name (Legal Business Name): DEBORAH SANTOS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 BELLE TERRE RD BLDG J
PORT JEFFERSON NY
11777-1936
US

IV. Provider business mailing address

640 BELLE TERRE RD BLDG J
PORT JEFFERSON NY
11777-1936
US

V. Phone/Fax

Practice location:
  • Phone: 631-828-5361
  • Fax: 631-828-5364
Mailing address:
  • Phone: 631-828-5361
  • Fax: 631-828-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: