Provider Demographics
NPI:1033533518
Name:SAMUEL, ANITHA SIMON (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANITHA
Middle Name:SIMON
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ANITHA
Other - Middle Name:
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:302 NEUMAIER DR
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1238
Mailing Address - Country:US
Mailing Address - Phone:201-265-5888
Mailing Address - Fax:
Practice Address - Street 1:302 NEUMAIER DR
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-1238
Practice Address - Country:US
Practice Address - Phone:201-265-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037359225100000X
NJPT40QA01043800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist