Healthcare Provider Details

I. General information

NPI: 1730126236
Provider Name (Legal Business Name): CHRISTINE ANNE SAMSON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE ANNE GERONIMO PT

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 WOOD DUCK CT
FREEHOLD NJ
07728-9522
US

IV. Provider business mailing address

50 RED FOX RD
FREEHOLD NJ
07728-8165
US

V. Phone/Fax

Practice location:
  • Phone: 732-677-2839
  • Fax: 732-677-2839
Mailing address:
  • Phone: 917-470-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01130100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: