Provider Demographics
NPI:1942813100
Name:CANLAS, JOHN PATRICK SANTOS (PT, DPT, SCS)
Entity Type:Individual
Prefix:
First Name:JOHN PATRICK
Middle Name:SANTOS
Last Name:CANLAS
Suffix:
Gender:M
Credentials:PT, DPT, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4919
Mailing Address - Country:US
Mailing Address - Phone:425-422-7754
Mailing Address - Fax:
Practice Address - Street 1:3155 WILLOW LN
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-4919
Practice Address - Country:US
Practice Address - Phone:805-494-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-09-14
Deactivation Date:2020-08-27
Deactivation Code:
Reactivation Date:2020-09-09
Provider Licenses
StateLicense IDTaxonomies
CA295154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist