Provider Demographics
NPI:1194023804
Name:SANTOS, REYNAN JULIO (PT)
Entity Type:Individual
Prefix:
First Name:REYNAN
Middle Name:JULIO
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14348 41ST AVE
Mailing Address - Street 2:APT 4F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1832
Mailing Address - Country:US
Mailing Address - Phone:908-305-0874
Mailing Address - Fax:
Practice Address - Street 1:14348 41ST AVE
Practice Address - Street 2:APT 4F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1832
Practice Address - Country:US
Practice Address - Phone:908-305-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist