Healthcare Provider Details

I. General information

NPI: 1497614267
Provider Name (Legal Business Name): JULIAN RAY SAMONTE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 GAS HOUSE PIKE
FREDERICK MD
21701-4971
US

IV. Provider business mailing address

6659 COLDSTREAM DR
NEW MARKET MD
21774-6809
US

V. Phone/Fax

Practice location:
  • Phone: 240-651-0149
  • Fax:
Mailing address:
  • Phone: 540-293-1897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6161
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: