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General NPI Number Information
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NPI Number | 1942793807
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN PHYSIO-THERAPY, LLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 2393 SOUTH CONGRESS AVE SUITE 125
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City | WEST PALM BEACH
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State | FL
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Zip | 33406
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Country | US
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Telephone | 561-253-6382
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Fax | 561-253-0437
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Provider Business Mailing Address
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Address Line | 5055 NORTHERN LIGHTS DR
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City | GREENACRES
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State | FL
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Zip | 33463-2037
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Country | US
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Telephone | 561-808-3030
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | EMMANUEL DANIEL BENONY
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Credential | DPT
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Telephone | 561-808-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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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 | PT27961
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License Number State | FL
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