MEDICARE: MAEGAN KING SAMPSON 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	P16121	NC

General Provider Information

NPI Number	:	1417317215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAEGAN KING SAMPSON PT

Provider Business Mailing Address
First Line	:	1517 N HOWE ST
Second Line	:	SUITE 4
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-2772
Country	:	US
Telephone Number	:	910-454-0064
Fax Number	:	910-454-0025

Provider Business Practice Location Address
First Line	:	1517 N HOWE ST
Second Line	:	SUITE 4
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-2772
Country	:	US
Telephone Number	:	910-454-0064
Fax Number	:	910-454-0025

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

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	02/02/2024

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Directions to “ MAEGAN KING SAMPSON PT” Practice Location

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