MEDICARE: SAMPAGUITA LOZANO-GRAHAM 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	225100000X	Physical Therapist	J1-0001691	DE

General Provider Information

NPI Number	:	1538806757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMPAGUITA LOZANO-GRAHAM PT

Provider Business Mailing Address
First Line	:	18738 RYAN CT
Second Line	:
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-9434
Country	:	US
Telephone Number	:	302-236-9545
Fax Number	:

Provider Business Practice Location Address
First Line	:	699 BETHANY LOOP UNIT 3
Second Line	:
City	:	BETHANY BEACH
State	:	DE
Zip	:	19930-9035
Country	:	US
Telephone Number	:	302-616-3651
Fax Number	:

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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Directions to “ SAMPAGUITA LOZANO-GRAHAM PT” Practice Location

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