Provider Demographics
NPI:1437600509
Name:SAMANT, AKSHAY
Entity Type:Individual
Prefix:
First Name:AKSHAY
Middle Name:
Last Name:SAMANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 LAKE WATERFORD WAY W
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-8412
Mailing Address - Country:US
Mailing Address - Phone:317-666-1277
Mailing Address - Fax:
Practice Address - Street 1:405 N WICKHAM RD STE 103
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8628
Practice Address - Country:US
Practice Address - Phone:321-327-8509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011827A225100000X
FLPT34416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist