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General NPI Number Information
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NPI Number | 1982984704
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE AND REHABILITATION CONSULTANT, LLC
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 6175 SW 192ND AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33332
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Country | US
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Telephone | 919-260-8760
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Fax |
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Provider Business Mailing Address
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Address Line | 6175 SW 192ND AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33332
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Country | US
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Telephone | 919-260-8760
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GREGORY SAMSON
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Credential | M.D.
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Telephone | 919-260-8760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME 99900
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License Number State | FL
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