Healthcare Provider Details

I. General information

NPI: 1053788737
Provider Name (Legal Business Name): JOHN CLAUDE SAMPSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 URBANA PIKE STE 105
IJAMSVILLE MD
21754-9411
US

IV. Provider business mailing address

3280 URBANA PIKE STE 105
IJAMSVILLE MD
21754-9411
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-8311
  • Fax: 301-694-3537
Mailing address:
  • Phone: 301-694-8311
  • Fax: 301-694-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28016
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number28016
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: