MEDICARE: SAMUEL CLARK ESPEY 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	087227	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	087227	OTHER	IA	IOWA PHYSICAL AND OCCUPATIONAL THERAPY BUREAU OF PROFESSIONAL LICENSURE

General Provider Information

NPI Number	:	1881101228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL CLARK ESPEY DPT

Provider Business Mailing Address
First Line	:	4725 MERLE HAY RD
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 6TH AVE N
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-3541
Country	:	US
Telephone Number	:	515-576-1138
Fax Number	:

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

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	01/08/2018

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