Provider Demographics
NPI:1275657637
Name:ADRIANZEN, SAMANTHA (RPT)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:ADRIANZEN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 S. W. 1 COURT
Mailing Address - Street 2:APT. #1023
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130
Mailing Address - Country:US
Mailing Address - Phone:786-200-0441
Mailing Address - Fax:305-228-6251
Practice Address - Street 1:4284 S. W. 161 PLACE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185
Practice Address - Country:US
Practice Address - Phone:786-208-2814
Practice Address - Fax:305-228-6251
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4801AMedicare ID - Type UnspecifiedMEDICARE B #