Provider Demographics
NPI:1689117707
Name:DESANTO, ALFONSE III (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALFONSE
Middle Name:
Last Name:DESANTO
Suffix:III
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020
Mailing Address - Country:US
Mailing Address - Phone:570-234-7562
Mailing Address - Fax:
Practice Address - Street 1:2030 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8963
Practice Address - Country:US
Practice Address - Phone:570-234-7562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0065982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer