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General NPI Number Information
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NPI Number | 1023198512
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Entity Type | Individual
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Provider Name | CHARLES D DISANTO PT,COMT,CHT
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 1 E WILLARD AVE SUITE B
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City | NORWALK
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State | OH
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Zip | 44857-1155
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Country | US
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Telephone | 419-660-0876
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Fax | 419-660-9104
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Provider Business Mailing Address
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Address Line | 4517 STATE ROUTE 269 S
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City | CASTALIA
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State | OH
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Zip | 44824-9356
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Country | US
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Telephone | 419-684-8091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT07840
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License Number State | OH
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