MEDICARE: SAMSON VICTOR CHIANG PT

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	2251G0304X	Geriatric Physical Therapist	PT0010931	FL

General Provider Information

NPI Number	:	1205015419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMSON VICTOR CHIANG PT

Provider Business Mailing Address
First Line	:	PO BOX 236
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33780-0236
Country	:	US
Telephone Number	:	727-743-0046
Fax Number	:	727-545-3305

Provider Business Practice Location Address
First Line	:	10707 66TH ST N STE 14
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-2336
Country	:	US
Telephone Number	:	727-547-8600
Fax Number	:	727-548-6131

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

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	03/08/2019

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