Healthcare Provider Details

I. General information

NPI: 1609754845
Provider Name (Legal Business Name): VINCENT SANTOS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 GRANBY ST STE B
NORFOLK VA
23504-1312
US

IV. Provider business mailing address

16803 NE 20TH ST
VANCOUVER WA
98684-6787
US

V. Phone/Fax

Practice location:
  • Phone: 757-423-8885
  • Fax: 757-423-8886
Mailing address:
  • Phone: 480-208-6593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.61689989
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP055937T
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308824
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP052139T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: