MEDICARE: IRINA SAMSON FN-P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach
2	225100000X	Physical Therapist	8130	SC

General Provider Information

NPI Number	:	1154107480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA SAMSON FN-P

Provider Business Mailing Address
First Line	:	1185 LANDSDOWNE DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-9722
Country	:	US
Telephone Number	:	443-631-7210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1185 LANDSDOWNE DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-9722
Country	:	US
Telephone Number	:	443-631-7210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	06/18/2026

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