Provider Demographics
NPI:1851682793
Name:SANTOS, NOEL DOLENDO (PT)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:DOLENDO
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 1:23 WESTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-4034
Mailing Address - Country:US
Mailing Address - Phone:386-793-6679
Mailing Address - Fax:386-246-3891
Practice Address - Street 1:23 WESTRIDGE LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-4034
Practice Address - Country:US
Practice Address - Phone:386-793-6679
Practice Address - Fax:386-246-3891
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist