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General NPI Number Information
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NPI Number | 1750931770
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Entity Type | Individual
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Provider Name | RICHARD SANTOS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 153 BERGEN BLVD
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City | FAIRVIEW
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State | NJ
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Zip | 07022-1941
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Country | US
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Telephone | 201-351-0878
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Fax |
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Provider Business Mailing Address
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Address Line | 233 4TH ST APT 1
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City | FAIRVIEW
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State | NJ
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Zip | 07022-1435
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Country | US
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Telephone | 201-449-6637
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40QA01871300
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License Number State | NJ
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