Provider Demographics
NPI:1811164791
Name:SANTOS, CHRISTIAN PHILIP DALAGAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTIAN PHILIP
Middle Name:DALAGAN
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5612
Mailing Address - Country:US
Mailing Address - Phone:443-813-8366
Mailing Address - Fax:
Practice Address - Street 1:493 BLACK OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6501
Practice Address - Country:US
Practice Address - Phone:973-692-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01312700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist