Provider Demographics
NPI:1558389783
Name:MONCURE, SAMUEL E III (PT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:E
Last Name:MONCURE
Suffix:III
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 1:32828 OCEAN REACH DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4658
Mailing Address - Country:US
Mailing Address - Phone:302-444-8318
Mailing Address - Fax:
Practice Address - Street 1:32828 OCEAN REACH DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4658
Practice Address - Country:US
Practice Address - Phone:302-444-8318
Practice Address - Fax:302-444-8309
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000936225100000X
DEJ10000936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE223319ZBSXMedicare PIN
DEG00716Medicare PIN