MEDICARE: SAMUEL LEE ECHOLS PT

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	225100000X	Physical Therapist	PT004801	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00319887	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396741583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL LEE ECHOLS PT

Provider Business Mailing Address
First Line	:	PO BOX 1975
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30162-1975
Country	:	US
Telephone Number	:	706-346-6035
Fax Number	:	866-858-7371

Provider Business Practice Location Address
First Line	:	519 BROAD ST STE 300
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-1736
Country	:	US
Telephone Number	:	706-346-6035
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/24/2025

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Directions to “ SAMUEL LEE ECHOLS PT” Practice Location

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