MEDICARE: SAMUEL SCARBOROUGH 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	1393594	TX

General Provider Information

NPI Number	:	1366334609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL SCARBOROUGH DPT

Provider Business Mailing Address
First Line	:	3045 MARINA BAY DR APT 7313
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2775
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 SPACE PARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3311
Country	:	US
Telephone Number	:	409-797-1477
Fax Number	:

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

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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Directions to “ SAMUEL SCARBOROUGH DPT” Practice Location

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