Provider Demographics
NPI:1215692132
Name:SANTOS, CLINT JONATHAN (PT)
Entity type:Individual
Prefix:
First Name:CLINT JONATHAN
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 1:26811 GROMMON WAY
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-6934
Mailing Address - Country:US
Mailing Address - Phone:213-359-8290
Mailing Address - Fax:
Practice Address - Street 1:25830 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2004
Practice Address - Country:US
Practice Address - Phone:661-259-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT301144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist