Healthcare Provider Details

I. General information

NPI: 1306073945
Provider Name (Legal Business Name): SAMS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 S. MAIN ST.
LESLIE MI
49251-9426
US

IV. Provider business mailing address

P.O. BOX 158
LESLIE MI
49251-0158
US

V. Phone/Fax

Practice location:
  • Phone: 517-589-9050
  • Fax: 517-589-9053
Mailing address:
  • Phone: 517-589-9050
  • Fax: 517-589-9059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5501012063
License Number StateMI

VIII. Authorized Official

Name: RANJITH SAMSON
Title or Position: OWNER
Credential: PT, DPT
Phone: 517-589-9050