Provider Demographics
NPI:1063286698
Name:SANTOS, SAMUEL (PT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
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 1:660 MERRIMON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3567
Mailing Address - Country:US
Mailing Address - Phone:828-348-1780
Mailing Address - Fax:877-922-4820
Practice Address - Street 1:660 MERRIMON AVE STE C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3567
Practice Address - Country:US
Practice Address - Phone:828-348-1780
Practice Address - Fax:877-922-4820
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP22773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist