MEDICARE: DR. JUSTIN RALPH SAMSON 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	1269506	TX
2	225100000X	Physical Therapist	PTL.0018558	CO

General Provider Information

NPI Number	:	1114387198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN RALPH SAMSON PT, DPT

Provider Business Mailing Address
First Line	:	12611 HYMEADOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-2700
Country	:	US
Telephone Number	:	512-996-0441
Fax Number	:

Provider Business Practice Location Address
First Line	:	12611 HYMEADOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-2700
Country	:	US
Telephone Number	:	512-996-0441
Fax Number	:

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

Provider Enumeration Date	:	03/03/2016
Last Update Date	:	05/31/2024

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