Provider Demographics
NPI:1548861461
Name:DELOSSANTOS, ERIC JAMES
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:DELOSSANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-1300
Mailing Address - Country:US
Mailing Address - Phone:214-686-3223
Mailing Address - Fax:972-724-2495
Practice Address - Street 1:12413 JUDSON RD STE 260
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3262
Practice Address - Country:US
Practice Address - Phone:210-656-7953
Practice Address - Fax:210-656-7957
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1327860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist