Healthcare Provider Details

I. General information

NPI: 1578118824
Provider Name (Legal Business Name): SAMUEL R LOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3129 VICENTE ST
SAN FRANCISCO CA
94116-2740
US

IV. Provider business mailing address

615 LILLY RD NE STE 240
OLYMPIA WA
98506-5117
US

V. Phone/Fax

Practice location:
  • Phone: 415-661-1057
  • Fax:
Mailing address:
  • Phone: 360-413-3850
  • Fax: 360-359-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309046
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT70016484
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number034004
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number63654
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: