Provider Demographics
NPI:1316115587
Name:SANTOS, MITZI MALILAY (PT)
Entity type:Individual
Prefix:MS
First Name:MITZI
Middle Name:MALILAY
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MITZI
Other - Middle Name:PLATON
Other - Last Name:MALILAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:46 FAITH LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6502
Mailing Address - Country:US
Mailing Address - Phone:516-280-5423
Mailing Address - Fax:
Practice Address - Street 1:46 FAITH LN
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6502
Practice Address - Country:US
Practice Address - Phone:516-280-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist