Healthcare Provider Details

I. General information

NPI: 1033976030
Provider Name (Legal Business Name): GRACE SANTOS MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MONUMENT RD
YORK PA
17403-5060
US

IV. Provider business mailing address

126 OAK RIDGE DR
YORK PA
17402-4615
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4090
  • Fax:
Mailing address:
  • Phone: 410-259-0959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRTO000583
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: