MEDICARE: MR. LEOPOLDO D SAMONTE 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	026092	NY

General Provider Information

NPI Number	:	1710989413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEOPOLDO D SAMONTE PT

Provider Business Mailing Address
First Line	:	2318 31ST ST
Second Line	:	SUITE 210
City	:	ASTORIA
State	:	NY
Zip	:	11105-2892
Country	:	US
Telephone Number	:	718-777-1885
Fax Number	:	718-777-9613

Provider Business Practice Location Address
First Line	:	2318 31ST ST
Second Line	:	SUITE 210
City	:	ASTORIA
State	:	NY
Zip	:	11105-2892
Country	:	US
Telephone Number	:	718-777-1885
Fax Number	:	718-777-9613

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. LEOPOLDO D SAMONTE PT” Practice Location

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