MEDICARE: MRS. ANNA LIZA SAMSON TEMPLO 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	40QA01203300	NJ

General Provider Information

NPI Number	:	1417038415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA LIZA SAMSON TEMPLO PT, DPT

Provider Business Mailing Address
First Line	:	784 FRANKLIN AVE STE 250
Second Line	:
City	:	FRANKLIN LAKES
State	:	NJ
Zip	:	07417-1306
Country	:	US
Telephone Number	:	844-777-0910
Fax Number	:	201-560-0712

Provider Business Practice Location Address
First Line	:	11 HOLT DR
Second Line	:
City	:	STONY POINT
State	:	NY
Zip	:	10980-1919
Country	:	US
Telephone Number	:	844-777-0910
Fax Number	:	201-560-0712

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	02/07/2020

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