Provider Demographics
NPI:1467872234
Name:SAMANIEGO, JOSE IV (PTRP,RPT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SAMANIEGO
Suffix:IV
Gender:M
Credentials:PTRP,RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 HAMPSHIRE GREEN LANE
Mailing Address - Street 2:APT # 24
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903
Mailing Address - Country:US
Mailing Address - Phone:443-763-1535
Mailing Address - Fax:
Practice Address - Street 1:4922 LA SALLE RD.
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782
Practice Address - Country:US
Practice Address - Phone:301-864-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist