Healthcare Provider Details

I. General information

NPI: 1679566632
Provider Name (Legal Business Name): JONATHAN S SAMS PT, DPT, OCS, SCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 CREEKSIDE PARK RD STE 200
SPRING BRANCH TX
78070-6240
US

IV. Provider business mailing address

17325 BELL NORTH DR
SCHERTZ TX
78154-3368
US

V. Phone/Fax

Practice location:
  • Phone: 830-980-4565
  • Fax:
Mailing address:
  • Phone: 888-590-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1126878
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: