Basic Information
| Provider Information | |||||||||
| NPI: | 1972501336 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMSON | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9221 PINE RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191154418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156982164 | ||||||||
| FaxNumber: | 2156731185 | ||||||||
| Practice Location | |||||||||
| Address1: | 9389 KREWSTOWN RD | ||||||||
| Address2: | NORTHEAST RAQUET CLUB | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191153710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156766760 | ||||||||
| FaxNumber: | 2156763746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT001869L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.