=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346717840
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMUEL DAVID STRONG III DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2018
-----------------------------------------------------
Last Update Date | 11/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13830 SAWYER RANCH RD STE 300
-----------------------------------------------------
City | DRIPPING SPRINGS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78620-5514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-894-2194
-----------------------------------------------------
Fax | 512-829-4682
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 W HIGHWAY 290 STE B300
-----------------------------------------------------
City | DRIPPING SPRINGS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78620-4051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-858-5191
-----------------------------------------------------
Fax | 512-858-5194
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------