Provider Demographics
NPI:1205015419
Name:CHIANG, SAMSON VICTOR (PT)
Entity Type:Individual
Prefix:
First Name:SAMSON
Middle Name:VICTOR
Last Name:CHIANG
Suffix:
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:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-0236
Mailing Address - Country:US
Mailing Address - Phone:727-743-0046
Mailing Address - Fax:727-545-3305
Practice Address - Street 1:10707 66TH ST N STE 14
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2336
Practice Address - Country:US
Practice Address - Phone:727-547-8600
Practice Address - Fax:727-548-6131
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT00109312251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics