MEDICARE: NOEMI LIEZL SAMBAS-HO PT, DPT

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	PT013040	GA
2	225100000X	Physical Therapist	PT61464275	WA

General Provider Information

NPI Number	:	1073038741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEMI LIEZL SAMBAS-HO PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 5299
Second Line	:	MS: 820-5-PCO
City	:	TACOMA
State	:	WA
Zip	:	98415-0299
Country	:	US
Telephone Number	:	253-459-8009
Fax Number	:

Provider Business Practice Location Address
First Line	:	6704 TACOMA MALL BLVD STE 100
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-9001
Country	:	US
Telephone Number	:	770-460-8609
Fax Number	:	770-460-8629

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

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	09/18/2023

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