Provider Demographics
NPI:1497491112
Name:GOMEZ SAMANIEGO, ANA MARIA (PT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:GOMEZ SAMANIEGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 PINNACLE ST STE 209
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1042
Mailing Address - Country:US
Mailing Address - Phone:915-494-2576
Mailing Address - Fax:
Practice Address - Street 1:4141 PINNACLE ST STE 209
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1042
Practice Address - Country:US
Practice Address - Phone:915-494-2576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist