Provider Demographics
NPI:1891946588
Name:SANTOS, CARLOS RAYMUND GOPIAD (BSPT/RPT)
Entity Type:Individual
Prefix:
First Name:CARLOS RAYMUND
Middle Name:GOPIAD
Last Name:SANTOS
Suffix:
Gender:M
Credentials:BSPT/RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2549
Mailing Address - Country:US
Mailing Address - Phone:732-494-3380
Mailing Address - Fax:732-494-3727
Practice Address - Street 1:69 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2549
Practice Address - Country:US
Practice Address - Phone:732-494-3380
Practice Address - Fax:732-494-3727
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01247800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist