MEDICARE: MR. SAMUEL THOMAS FORESTER P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	04559	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5DW93	OTHER	LA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023066156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL THOMAS FORESTER P.T.

Provider Business Mailing Address
First Line	:	3016 JACKSON ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-4743
Country	:	US
Telephone Number	:	318-445-4455
Fax Number	:	318-445-5574

Provider Business Practice Location Address
First Line	:	3016 JACKSON ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-4743
Country	:	US
Telephone Number	:	318-445-4455
Fax Number	:	318-445-5574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/13/2012

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Directions to “ MR. SAMUEL THOMAS FORESTER P.T.” Practice Location

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