Provider Demographics
NPI:1780262212
Name:SANTOS, MICHAEL JAMES (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
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 1:334 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-5130
Mailing Address - Country:US
Mailing Address - Phone:318-727-9377
Mailing Address - Fax:318-727-8915
Practice Address - Street 1:204 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-2717
Practice Address - Country:US
Practice Address - Phone:318-727-9377
Practice Address - Fax:318-727-8915
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05036F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty