Healthcare Provider Details

I. General information

NPI: 1871832840
Provider Name (Legal Business Name): SAMUEL FRANK BELL III DPT, PT, MS, ATC, PE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5972 EDMONDS CIR
HUNTINGTON BEACH CA
92649-3704
US

IV. Provider business mailing address

5972 EDMONDS CIR
HUNTINGTON BEACH CA
92649-3704
US

V. Phone/Fax

Practice location:
  • Phone: 203-856-0846
  • Fax:
Mailing address:
  • Phone: 203-856-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number24077
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: