=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497554240
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOLLAN JOSE ARIOLA SANTOS PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2025
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 157 S. CENTRAL PARK AVENUE
-----------------------------------------------------
City | HARTSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-428-9698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1311 MAMARONECK AVE STE 140
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10605-5224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 053908
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------