Provider Demographics
NPI:1093332223
Name:MAUNES, SAMUEL III (PT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MAUNES
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 W 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3367
Mailing Address - Country:US
Mailing Address - Phone:219-944-4160
Mailing Address - Fax:219-944-4195
Practice Address - Street 1:2269 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3367
Practice Address - Country:US
Practice Address - Phone:219-944-4160
Practice Address - Fax:219-944-4195
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007136A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist