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NPI Code Detail

MEDICARE: CHRISTIAN PHILIP DALAGAN SANTOS PT, DPT

MEDICARE: CHRISTIAN PHILIP DALAGAN SANTOS PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist40QA01312700NJ

General Provider Information

NPI Number : 1811164791
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIAN PHILIP DALAGAN SANTOS PT, DPT
Provider Business Mailing Address
First Line : 100 BEECHWOOD DR
Second Line :
City : WAYNE
State : NJ
Zip : 07470-5612
Country : US
Telephone Number : 443-813-8366
Fax Number :
Provider Business Practice Location Address
First Line : 493 BLACK OAK RIDGE RD
Second Line :
City : WAYNE
State : NJ
Zip : 07470-6501
Country : US
Telephone Number : 973-692-9500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2008
Last Update Date : 03/04/2020

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