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NPI Code Detail

MEDICARE: BEVERLY R. SAMSON PT

MEDICARE: BEVERLY R. SAMSON 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
1225100000XPhysical TherapistPT001869LPA

General Provider Information

NPI Number : 1972501336
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEVERLY R. SAMSON PT
Provider Business Mailing Address
First Line : 9221 PINE RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-4418
Country : US
Telephone Number : 215-698-2164
Fax Number : 215-673-1185
Provider Business Practice Location Address
First Line : 9389 KREWSTOWN RD
Second Line : NORTHEAST RAQUET CLUB
City : PHILADELPHIA
State : PA
Zip : 19115-3710
Country : US
Telephone Number : 215-676-6760
Fax Number : 215-676-3746
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 07/08/2007

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