Healthcare Provider Details

I. General information

NPI: 1043288236
Provider Name (Legal Business Name): JOHN PATRICK SANTOS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 TYRRELL ST
STATEN ISLAND NY
10307-1166
US

IV. Provider business mailing address

132 TYRRELL ST
STATEN ISLAND NY
10307-1166
US

V. Phone/Fax

Practice location:
  • Phone: 718-227-3218
  • Fax: 718-227-3218
Mailing address:
  • Phone: 718-227-3218
  • Fax: 718-227-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015652-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number015652-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number015652-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: