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General NPI Number Information
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NPI Number | 1306115621
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Entity Type | Individual
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Provider Name | SAMY S TADROS PT
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Gender | Male
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 1075 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4690
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Country | US
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Telephone | 386-255-4596
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Fax | 386-257-0558
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Provider Business Mailing Address
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Address Line | 1075 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4690
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Country | US
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Telephone | 386-255-4596
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Fax | 386-257-0558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305209874
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 031785
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT30815
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30815
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License Number State | FL
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