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General NPI Number Information
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NPI Number | 1689204752
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Entity Type | Individual
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Provider Name | SUSANNA SAMUEL PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 4600 FAIRMONT PKWY STE 205
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City | PASADENA
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State | TX
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Zip | 77504-3337
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Country | US
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Telephone | 281-998-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 5419 POINTED LEAF DR
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City | MISSOURI CITY
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State | TX
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Zip | 77459-1599
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Country | US
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Telephone | 281-770-2265
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Fax |
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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 | 1324650
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License Number State | TX
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