MEDICARE: MR. ARIZ SAM AMARIA R.P.T

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	PT19663	FL

General Provider Information

NPI Number	:	1942291760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARIZ SAM AMARIA R.P.T

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	FORTSON
State	:	GA
Zip	:	31808-0370
Country	:	US
Telephone Number	:
Fax Number	:	706-494-3008

Provider Business Practice Location Address
First Line	:	SOUTHERN ORTHOPEDIC SPECIALIST PA
Second Line	:	1827 HARRISON AVENUE BLDG# 4
City	:	PANAMA CITY
State	:	FL
Zip	:	32405
Country	:	US
Telephone Number	:	850-872-7022
Fax Number	:	850-872-7021

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

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	06/08/2020

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