Provider Demographics
NPI:1801049085
Name:SANTOS, LISSA ADELINE TUASON (PT)
Entity type:Individual
Prefix:
First Name:LISSA ADELINE
Middle Name:TUASON
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISSA
Other - Middle Name:ADELINE
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:45 PONDFIELD ROAD WEST
Mailing Address - Street 2:APT. 2K
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2686
Mailing Address - Country:US
Mailing Address - Phone:914-787-8525
Mailing Address - Fax:914-787-8525
Practice Address - Street 1:45 PONDFIELD RD W
Practice Address - Street 2:APT. 2K
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2686
Practice Address - Country:US
Practice Address - Phone:914-787-8525
Practice Address - Fax:914-787-8525
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013271-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist